Introduction: Failure to extubate refers to the inability to sustain spontaneous breathing after removing an artificial airway within 48 hours of extubation. This is due to severe respiratory distress caused by COVID-19 infection. The prevalence and predictors of failure to extubate in COVID-19 patients can vary depending on several factors, including the severity of the disease, characteristics of the patient population studied, and the specific criteria used to define extubation failure. Treatment strategies can also significantly influence outcomes. Objectives: To assess the prevalence, possible predictors, and outcomes of failure to extubate adult COVID-19 patients who were admitted to intensive care units in the Sultanate of Oman. Methods: This is a multi-center, cross-sectional, retrospective, case-control design study. Patients (18 years or older) Adult COVID-19 patients who were invasively ventilated and admitted to ICU in Sultan Qaboos University Hospital and Royal Hospital either successfully extubated or not from February 2020 to February 2022, were included. Results: The study included 356 patients. Of 356 patients, 25.6% (n = 91) failed to extubate, and 74.4% (n = 265) were successfully extubated. Multivariate logistic regression analysis showed increased odds of failure to extubate risks associated with comorbidities (p 0.001), existing infection (OR = 0.226, 95% CI: 0.126 - 0.408; p 0.001), length of mechanical ventilation (OR = 0.048, 95% CI: 0.008 – 0.291, p 0.001), antiviral (OR = 0.192, 95% CI .071-0.519; p 0.001). The results also showed that the oxygenation index significantly predicted failure to extubate invasively ventilated patients with COVID-19 (OR = 0.001, CI = .110 - 0.465, p 0.01). Conclusions: The prevalence of failure to extubate is 9.74 among adults ICU patients ventilated invasively with Coronavirus who failed to extubate in this study. The study demonstrates the importance of early intervention and prediction of failure to extubate patients with coronavirus ARDS to prevent inpatient mortality and aims for early intervention and management. All healthcare professionals can use the data provided here to control and reduce the risk of failure to extubate and prevent complications.