We thank Rubin et al. for their thoughtful discourse on the intubateCOVID study reporting emergency airway management in COVID-19 patients.2,3  We welcome the discussion our article has invited. We agree that patients with COVID-19 requiring tracheal intubation are often physiologically compromised, having failed noninvasive means for respiratory support, and that first-pass success is an imperfect outcome measure for assessing risks to patients during tracheal intubation. Their account of the physiologic derangements that can occur with induction of anesthesia and transition to positive pressure ventilation mirrors our own experiences in managing this cohort of patients.

Our study has limitations with the incomplete patient-level data that may help us truly interpret the physiologic impact of tracheal intubation in this setting. We can, however, infer from these data that physiologic and anatomical difficulty are not mutually exclusive. First-pass success is a surrogate for overall ease of performing the...

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