key: cord-0831163-4shm9su2
authors: Shamim, Faisal; Nazir, Mohsin; Sheikh, Naseem A.; Salam, Asma; Afzal, Badar
title: Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry
date: 2022-03-17
journal: Saudi J Anaesth
DOI: 10.4103/sja.sja_743_21
sha: d85125925f01e39e35abae50fdbebb301514f7bc
doc_id: 831163
cord_uid: 4shm9su2

nan

To the Editor, Airway management procedures are considered high risk for viral spread and may expose healthcare workers (HCWs) to coronavirus disease . [1] Tracheal intubation in these patients poses a unique set of challenges, combining complex time-critical tasks in physiologically difficult airways. Despite many publications of protocols and guidelines, there was a dearth of evidence available describing the manner in which the COVID-19 pandemic changed the practice of emergency airway management, its outcomes, and associated complications. However, what is now known is that there are variabilities in practice across different settings and countries. [2] In March 2020, a prospective, international, multicentre cohort study, intubateCOVID was launched to gather information about HCWs involved in tracheal intubation of suspected or confirmed COVID-19 patients, with Pakistan becoming collaborating site in May 2020 [Supplementary Material S1]. Exemption from ethical approval for formal research was given by ethics review committee (ERC) of Aga Khan University on 24 th May, 2020. The other two hospitals have also provided ethical approval/waiver from their respective ERC. Participants reported details of personal protective equipment, airway management procedure characteristics, health outcomes, and personnel involved. We present data from Pakistan from this international registry and discuss their implications. We restricted the present analysis to providers who recorded an airway procedure in which they directly performed an intubation.

Twenty HCWs from three hospitals recorded at least one tracheal intubation in a patient with COVID-19, and then reported their health outcomes. Between May 2020 and March 2021, 184 tracheal intubations in COVID patients were performed, of which 86% were males. The primary indication for tracheal intubation was deteriorating respiratory condition and 78% tracheal intubations were performed by anesthesiologist, followed by emergency medicine physicians (22%). Table 1 summarizes the provider and airway procedure characteristics as frequencies.

Videolaryngoscope was used for first attempt laryngoscopy in 112 (61%) patients while direct laryngoscopy (DL) was chosen in 71 (38.5%). There was a high first attempt success rate (89.6%). Increased number of DL using a Macintosh blade may be explained by unavailability of VL in early part of pandemic due to supply--demand disparity or its preference by some personnel. Only one patient required fiberoptic intubation who was confirmed COVID-19 positive. 141 (76.6%) Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry intubations were performed by consultants while 39 (21.2%) by trainees, consistent with suggestions in guidelines for involving most senior airway manager. [3] Adherence to WHO personal protective equipment standards were mostly observed in our data set. Also, presence of staff in the intubation room (3.1 ± 0.6) was also found in line with different societies recommendations for minimizing the number. [4] The mean (SD) age of HCWs reported their follow-up data, which was 34.5 (5). Laboratory confirmed PCR was reported by six participants (2.8%) and nine (4.2%) had to isolate themselves due to high risk exposure. Sore throat, cough, and fatigue were the most observed signs and symptoms.

This represents a small sample of registry data from a low-middle income country. Although the subset may not be truly reflective of airway management practices in COVID-19 on a larger scale, it still gives insight and comparison with other settings. Pakistan is facing fourth wave currently with the emergence of the delta variant of SARS-CoV-2 and being spread across country with positivity rate rose to 9% in August 2021. The findings and recommendations by intubateCOVID registry are valuable in guiding departmental/ institutional policies for airway management.

IntubateCOVID research project received financial support from the Difficult Airway Society (UK), the American Society of Anesthesiologists, the International Anesthesia Research Society and the Anesthesia Patient Safety Foundation.

There are no conflicts of interest.

An electronic file is provided containing names of intubateCOVID Pakistan Collaborators and the intubateCOVID International Coordinating Centre.

Risks to healthcare workers following tracheal intubation of patients with COVID-19: A prospective international multicentre cohort study

intubateCOVID Canadian collaborators, intubateCOVID Canadian collaborators and the 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

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

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group

Naseem Ali Sheikh (Anaesthesia and Critical Care, Hameed Latif Hospital, Lahore), Mujahid Ul Islam (Cardiothoracic Anesthesia, Rehman medical institute, Peshawar) intubateCOVID International Coordinating Centre** **intubateCOVID International Coordinating Centre

Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust

Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.How to cite this article: Shamim F, Nazir M, Sheikh NA, Salam A, Afzal B. Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry. Saudi J Anaesth 2022;16:251-2.