Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists

Abstract

Severe acute respiratory syndrome-corona virus-2, which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.

Keywords: COVID-19; airway; anaesthesia; coronavirus; critical care; difficult airway; intubation.

© 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

Figures

Figure 1

One‐page summary for emergency tracheal intubation of the coronavirus disease 2019 patient.

Figure 2

Principles of coronavirus disease 2019 airway management.

Figure 3

MACOCHA score and prediction of difficult intubation. Adapted from 23.

Figure 4

Personnel plan for tracheal intubation of a patient with coronavirus disease 2019. Adapted from 20.

Figure 5

Exemplar of kit dump mat. The emergency front‐of‐neck airway kit may be excluded from the airway kit dump due to the risk of contamination and could be placed outside of the room with immediate access if required.

Figure 6

(a). Two‐handed two‐person bag‐mask technique with the VE hand position; the second person squeezes the bag. (b). The C hand position, which should be avoided. Reproduced with permission of Dr A. Matioc.

Figure 7

Emergency tracheal intubation checklist in a patient with coronavirus disease 2019. Adapted from 20 with permission.

Figure 8

Cognitive aids for use when managing unexpected difficulty when intubating a patient with coronavirus disease 2019. (a) Unexpected difficult tracheal intubation. (b) Cannot intubate, cannot oxygenate. Adapted from 20 with permission. (c) Vortex approach cognitive aid. From 27 with permission.