A retrospective evaluation of characterization, clinical course and anaesthesia management of emergency trauma surgical patients during first wave of COVID-19 pandemic at a tertiary care center in India

Abstract

: The COVID-19 pandemic resulted in nationwide lockdown followed by phased unlock to break the chain of transmission of the SARS-CoV-2 virus in India. Management of emergency trauma patients has been particularly challenging for anaesthesiologists in order to treat these high risk group of patients and preventing cross infection to healthy patients as well as health care personnel. : It is a single centre retrospective observational cohort study conducted at tertiary care hospital in North India in the patients who underwent emergency trauma surgeries during 31 March 2020-31 May 2020(Lockdown) and compared with data from 1 June 2020-31 July 2020(Unlock). To compare the effect of lockdown and unlock during first wave of Covid-19 pandemic on the volume of emergency trauma surgical patients operated within 24 hours of admission.: To evaluate the difference between the two periods of lockdown and unlock a) in the mortality rates b) covid status c) the length of hospital stay d) the mechanism of injury e)severity of injury f)proportion of aerosol generating procedures (AGP) utilized and g)demographics of the patients. Our anaesthesia experience of managing the patients differently in the pandemic, identify areas for improvement, particularly in terms of minimising exposure and optimising resource usage in the management of such emergency patients in the event of a future healthcare crisis is also discussed. Over the 2 periods of lockdown and unlock there was no statistical difference in number, age or sex distribution of the patients presenting for emergency trauma surgery. Number of covid positive patients were slightly higher during unlock but it was statistically insignificant (p=0.07) and the number of patients died during unlock was also higher during unlock as compared to lockdown but statistically insignificant(p=0.3). The median injury severity score and length of stay was also not statistically significant between two periods. Road traffic accidents were most common type of injury in both the groups, self-inflicted injury occurred in 5 patients during lockdown and zero during unlock, none of these showed a significant difference (p > 0.06). General anaesthesia was the most common anaesthesia technique used in both the periods.Emergency trauma surgeries will continue to occur even in different phases of pandemics, anaesthesiologists should plan and prepare appropriately to provide anaesthesia and emergency care to these patients and prevent cross infection in healthy patients and health care workers.