Abstract
This retrospective observational case series describes a single centre's preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p=0.610) and lower first-pass success (0% vs. 92%, p < 0.001). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)—specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.
Highlights
Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels
It combines complex timecritical tasks in physiologically difficult airways, with heightened clinician anxieties relating to personal protective equipment (PPE) and health risk from viral exposure associated with aerosol-generating procedures (AGPs) [6]
Recognising that situational awareness, decision-making, and team performance during tracheal intubation may be negatively affected by clinician anxiety, we rapidly modified our standard approach to emergency airway management in critically ill patients, implementing a comprehensive dedicated COVID-19 airway management strategy
Summary
Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels. Recognising that situational awareness, decision-making, and team performance during tracheal intubation may be negatively affected by clinician anxiety, we rapidly modified our standard approach to emergency airway management in critically ill patients, implementing a comprehensive dedicated COVID-19 airway management strategy. In this case series, we outline our local airway management preparations and subsequent experience of emergency tracheal intubation in COVID-19 patients. We explored technical and nontechnical aspects of airway management using an online survey, completed by intubation team members, investigating factors contributing towards anxiety
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