key: cord-1007678-58ocb3gp authors: Parotto, Matteo; Cavallin, Francesco; Bryson, Gregory L.; Chin, Ki Jinn title: Risks to healthcare workers following tracheal intubation of patients with known or suspected COVID-19 in Canada: data from the intubateCOVID registry date: 2021-01-11 journal: Can J Anaesth DOI: 10.1007/s12630-020-01890-3 sha: 47cc635492957f48241e26d1ee55ae307c9360a6 doc_id: 1007678 cord_uid: 58ocb3gp nan Airway management may expose healthcare workers (HCWs) to the risk of contracting coronavirus disease . 1 This exposure may occur in a broad range of clinical scenarios, from intubation of asymptomatic individuals undergoing elective surgery to emergent airway management for COVID-19-related respiratory failure. While efforts have been made to assess the magnitude of this risk, definitive data are lacking, and variability may exist across different settings and countries. A prospective, international, quality improvement project (intubateCOVID; https://www.intubatecovid.org/ info) was launched to collect information on HCWs involved in tracheal intubation of patients with suspected or confirmed COVID-19. 2 Table summarizes the details. Participants were the primary intubator in most procedures. Respiratory failure was the main indication for intubation and 75% were performed in the intensive care unit or emergency department. Rapid sequence induction was most commonly employed, a videolaryngoscope was the first-line device, and there was a high first-attempt success rate. Two emergency front-of-neck airways (eFONA) were reported (one in the resuscitation of a cardiac arrest, where eFONA was performed after two failed videolaryngoscopy attempts, and another where FONA was the first airway attempt in a patient with laryngeal trauma from a stab injury). Laboratory-confirmed COVID-19 was reported in one HCW five days after the intubation (1/54 HCWs, 1.9%; one HCW/136 intubations, 0.7%). Two HCWs self-isolated because of symptoms (but subsequently tested negative for COVID-19) six and 23 days after the intubation, respectively (2/54 HCWs, 3.7%; 2 HCWs/136 intubations, 1.5%). Personal protective equipment (PPE) was widely used, but World Health Organization recommended standards 3 were not met in five procedures (all occurring in March and April; reasons for these safety breaches could not be ascertained). The recommendation of minimizing the number of HCWs in the room to mitigate risk exposure 4,5 was broadly followed (median [IQR] 3 [3] [4] ), but up to 10-12 individuals were present in two intubations (details of these events were not available). Minimizing unnecessary HCW exposure remains an important focus and establishing dedicated airway response teams may help in this regard. Our findings should be interpreted within the limitations of a voluntary selfreported registry. The data undoubtedly represent only a small sample of COVID-19-related intubations performed in Canada, and a causal link between participation in airway management and subsequent COVID-19 infection cannot be ascertained. At the time of writing, Canada is into its second wave of COVID-19 infections, and data from continued participation in registries such as intubateCOVID will be valuable in guiding healthcare management policies. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance Resuscitation Council UK. Resuscitation Council UK statement on COVID-19 in relation to CPR and resuscitation in healthcare settings Airway management in the operating room and interventional suites in known or suspected COVID-19 adult patients: a practical review Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Disclosures None. Editorial responsibility This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.