Abstract
The COVID-19 pandemic presents significant concerns surrounding the risk of transmission to health care workers involved in airway management of patients with suspected or known infection. Limited evidence has been available to guide the preparation of staff, intubation environments, team structure and personal protective equipment. Our study invited Victorian hospitals to complete a survey on their airway management practices and protocols, in order to assess the degree of variability in practice and preparedness. Twenty hospitals responded in September 2020, during Victoria’s second wave of COVID-19. Forty percent had dedicated COVID-19 intubation teams, all including consultant anaesthetists. Seventy-five percent had negatively pressured dedicated intubation rooms. All provided airborne precautions including N95 masks for airway and cardiac arrest management of suspected or confirmed COVID-19 positive patients, with 35 per sent providing N95 mask fit-testing and 15 per cent providing powered air purifying respirators or elastomeric respirators. Thirty-five percent provided airborne precautions for cardiac arrest management of patients not suspected to be COVID-19 positive. Significant inter-hospital variations were reported in airway management practices, such as pre-oxygenation, bag-mask ventilation, medications and techniques to minimise aerosolisation. Although some of this variation was likely due to individual hospital infrastructure and resource limitations, it would be ideal to achieve a more consistent, standardised approach across Victorian hospitals. This study may highlight areas for improvement for some hospitals. These areas for improvement may include consideration of the establishment of COVID-19 intubation teams in at least major metropolitan hospitals, N95 mask fit-testing, and the use of airborne precautions for cardiac arrest management during times of increased community prevalence of COVID-19.
Highlights
The World Health Organization (WHO) declared the 2019 novel coronavirus (COVID-19) to be a pandemic on 11 March 20201
Several guidelines gradually became available as new information emerged, to guide medical professionals on airway management of suspected and confirmed COVID-19 positive patients, including those released by the Safe Airway Society[7], the Anesthesia Patient Safety Foundation[8], the Australian Society of Anaesthetists[3] and the Australian and New Zealand Intensive Care Society[9]
We excluded hospitals whose emergency department (ED) only caters for psychiatric patients. These inclusion and exclusion criteria were selected in order to encompass hospitals that would be expected to manage the airway of a COVID-19 positive patient requiring intubation
Summary
The World Health Organization (WHO) declared the 2019 novel coronavirus (COVID-19) to be a pandemic on 11 March 20201. One study showed that one in ten health care workers who were involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 e-12. Hospitals around the world, including those in Australia, had to promptly develop airway management guidelines and protocols with very limited supporting literature at the beginning of the pandemic[6]. Several guidelines gradually became available as new information emerged, to guide medical professionals on airway management of suspected and confirmed COVID-19 positive patients, including those released by the Safe Airway Society[7], the Anesthesia Patient Safety Foundation[8], the Australian Society of Anaesthetists[3] and the Australian and New Zealand Intensive Care Society[9]. Variations in practice among hospitals have been reported[10]
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