Objective: Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. In this case series we describe the pre-hospital management of three patients with critical respiratory failure due to Covid-19. All presented with severe hypoxemia refractory to supplemental oxygen. The specific cause of hypoxemia in these patients is a matter of speculation, and several mechanisms have been suggested. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting. Methods: Three cases with similar clinical presentation were identified at two bases within the Norwegian national helicopter emergency medical service (HEMS) system. The HEMS units are manned by a consultant anesthesiologist, a HEMS crew member and a pilot. Patients´ next of kin and the Regional committee for medical and health research ethics have approved the publication of this report. Conclusion: Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the prehospital emergency services. Covid-19 patients with hypocapnic hypoxia and a high minute ventilation demand high oxygen flow rates in order to avoid dilution of oxygen with ambient air, which is difficult to achieve with non-rebreathers and disposable CPAP systems. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary.
Pre-Hospital Critical Care Management of Severe Hypoxemia in Victims of Covid-19: A Case Series