Abstract 224: Videographic Assessment of Pediatric Endotracheal Intubation in the Covid-19 Era: A Report From the Videography in Pediatric Resuscitation Collaborative

Abstract

Introduction: Endotracheal intubation (ETI) of critically ill children is a high acuity, low frequency procedure in the pediatric emergency department that presents unique challenges to both pediatric and general acute care providers. COVID-19 and the associated requirements for PPE use, limitations of in-room personnel, communication difficulties, and reorganization of equipment have created new complexities. Objective: To use video review to compare intubator training level, first-attempt ETI success and presence of hypoxia during ETI attempts in the pediatric emergency department in the pre-COVID and COVID era. Methods: This is a retrospective multi-center case series of videorecordings of endotracheal intubations at the four tertiary care pediatric emergency departments comprising the VIPER Collaborative. All children undergoing emergent ETI between 1/1/2019-6/1/2020 in whom videorecordings were available were included for analysis. Data on patient age and intubator background was collected. Outcomes were first-attempt intubation success and hypoxia, defined as SpO2 <90%. Data was compared before (PRE) and after (POST) implementation of COVID-19 airway protocols, which each PED adopted in March 2020. Univariate analysis comparing PRE and POST for both outcomes was done by c2 testing. Multivariate analysis with a generalized estimating equation to control for clustering by site was done to determine the independent association between PRE and POST and outcomes. Results: Between 1/1/2019 and 6/1/2020, a total of 272 patients underwent ETI (239 PRE, 33 POST). Overall first attempt success was 155/239 (65%) in PRE and 28/33 (85%) in POST (p=0.02). Hypoxia was noted in 15% of PRE patients and in 12% of POST patients. Analysis of the training level of the intubator was notable for a significant increase in the number of intubations performed by anesthesiologists (55% POST vs. 13% PRE, p<0.001). In multivariate analysis controlling for intubator background, the POST phase was associated with greater first attempt success (AOR 2.4, 95% CI 1.6 – 3.7). Conclusion: Pediatric ETI in the COVID-19 era is associated with increased first attempt success when compared to the pre-COVID era.