A specialized airway management team for COVID-19 patients: a retrospective study of the experience of two Canadian hospitals in Toronto

Nicola Jarvis, Simone Schiavo, Justyna Bartoszko, Martin Ma, Ki Jinn Chin, Matteo Parotto, Nicola Jarvis, Simone Schiavo, Justyna Bartoszko, Martin Ma, Ki Jinn Chin, Matteo Parotto

Abstract

Background: In the COVID-19 pandemic, an unprecedented number of individuals required endotracheal intubation. To safely face these challenges, expert intubation teams were formed in some institutions. Here, we report on the experience of emergency rapid intubation teams (ERITs) in two Canadian hospitals.

Methods: We retrospectively collected data on all airway management procedures in confirmed or suspected COVID-19 patients performed by ERITs at two academic hospitals between 3 April and 17 June 2020. The co-primary outcomes were incidence of periprocedural adverse events (hypoxemia, hypotension, and cardiac arrest within 15 min of intubation) and first-attempt intubation success rate. Secondary outcomes included number of intubation attempts, device used to achieve successful airway management, and adherence to personal protective equipment (PPE) protocols.

Results: During the study period, 123 patients were assessed for airway management, with 117 patients receiving airway interventions performed by the ERIT. The first-attempt success rate for intubation was 92%, and a videolaryngoscope was the final successful device in 93% of procedures. Hypoxemia (peripheral oxygen saturation [SpO2] < 90%) occurred in 28 patients (24%) and severe hypoxemia (SpO2 < 70%) occurred in ten patients (9%). Hypotension (systolic blood pressure [SBP] < 90 mm Hg) occurred in 37 patients (32%) and severe hypotension (SBP < 65 mm Hg) in 11 patients (9%). Adherence to recommended PPE use among providers was high.

Conclusion: In this cohort of critically ill patients with respiratory failure requiring time-sensitive airway management, specialized ERIT teams showed high rates of successful airway management with high adherence to PPE use. Hypoxemia and hemodynamic instability were common and should be anticipated within the first 15 min following intubation.

Study registration: www.ClinicalTrials.gov (NCT04689724); registered 30 December 2020.

Keywords: COVID-19; airway management.

© 2021. Canadian Anesthesiologists' Society.

References

    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242. doi: 10.1001/jama.2020.2648.
    1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545–1546. doi: 10.1001/jama.2020.4031.
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–2059. doi: 10.1001/jama.2020.6775.
    1. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan's experience. Anesthesiology. 2020;132:1317–1332. doi: 10.1097/ALN.0000000000003296.
    1. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012 doi: 10.1371/journal.pone.0035797.
    1. Caputo KM, Byrick R, Chapman MG, Orser BJ, Orser BA. Intubation of SARS patients: infection and perspectives of healthcare workers. Can J Anesth. 2006;53:122–129. doi: 10.1007/BF03021815.
    1. El-Boghdadly K, Wong DJ, Owen R, et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia. 2020;75:1437–1447. doi: 10.1111/anae.15170.
    1. Brewster DJ, Chrimes N, Do TB, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 2020;212:472–481. doi: 10.5694/mja2.50598.
    1. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. 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. Anaesthesia. 2020;75:785–799. doi: 10.1111/anae.15054.
    1. Jabre P, Avenel A, Combes X, et al. Morbidity related to emergency endotracheal intubation–a substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517–522. doi: 10.1016/j.resuscitation.2011.01.015.
    1. Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The physiologically difficult airway. West J Emerg Med. 2015;16:1109–1117. doi: 10.5811/westjem.2015.8.27467.
    1. Russotto V, Myatra SN, Laffey JG, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021;325:1164–1172. doi: 10.1001/jama.2021.1727.
    1. Ahmad I, Jeyarajah J, Nair G, et al. A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams. Can J Anesth. 2021;68:196–203. doi: 10.1007/s12630-020-01804-3.
    1. World Health Organization. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance, 6 April 2020. Available from URL: (accessed October 2021).
    1. Brown CA, 3rd, Mosier JM, Carlson JN, Gibbs MA. Pragmatic recommendations for intubating critically ill patients with suspected COVID-19. J Am Coll Emerg Physicians Open. 2020;1:80–84. doi: 10.1002/emp2.12063.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-7.
    1. Prasad K, Jaeschke R, Wyer P, Keitz S, Guyatt G; Evidence-Based Medicine Teaching Tips Working Group. Tips for teachers of evidence-based medicine: understanding odds ratios and their relationship to risk ratios. J Gen Intern Med 2008; 23: 635-40.
    1. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol. 2007;165:710–718. doi: 10.1093/aje/kwk052.
    1. Lapinsky SE. Endotracheal intubation in the ICU. Crit Care. 2015 doi: 10.1186/s13054-015-0964-z.
    1. Ishimaru T, Goto T, Takahashi J, et al. Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department. Sci Rep. 2019 doi: 10.1038/s41598-019-53360-6.
    1. April MD, Arana A, Schauer SG, et al.; NEAR Investigators. Ketamine versus etomidate and peri-intubation hypotension: a National Emergency Airway Registry study. Acad Emerg Med 2020; 27: 1106-15.
    1. Mosier JM, Sakles JC, Law JA, Brown CA 3rd, Brindley PG. Tracheal intubation in the critically ill. Where we came from and where we should go. Am J Respir Crit Care Med 2020; 201: 775-88.
    1. Wong DJ, El-Boghdadly K, Owen R, et al. Emergency airway management in patients with COVID-19: a prospective international multicenter cohort study. Anesthesiology. 2021 doi: 10.1097/ALN.0000000000003791.
    1. Parotto M, Cavallin F, Bryson GL, Chin KJ; intubateCOVID Canadian collaborators; intubateCOVID International Coordinating Centre. Risks to healthcare workers following tracheal intubation of patients with known or suspected COVID-19 in Canada: data from the intubateCOVID registry. Can J Anesth 2021; 68: 425-7.
    1. Loh PS, Chaw SH, Shariffuddin II, Ng CC, Yim CC, Hashim NH. A developing nation's experience in using simulation-based training as a preparation tool for the coronavirus disease 2019 outbreak. Anesth Analg. 2021;132:15–24. doi: 10.1213/ANE.0000000000005264.
    1. Pan D, Rajwani K. Implementation of simulation training during the COVID-19 pandemic: a New York hospital experience. Simul Healthc. 2021;16:46–51. doi: 10.1097/SIH.0000000000000535.
    1. Andonian J, Kazi S, Therkorn J, et al. Effect of an intervention package and teamwork training to prevent healthcare personnel self-contamination during personal protective equipment doffing. Clin Infect Dis. 2019;69(Suppl 3):S248–S255. doi: 10.1093/cid/ciz618.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever