Complications associated with paediatric airway management during the COVID‐19 pandemic: an international, multicentre, observational study

Abstract

Summary Respiratory adverse events in adults with COVID‐19 undergoing general anaesthesia can be life‐threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID‐19. We created an international observational registry to collect airway management outcomes in children with COVID‐19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID‐19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test‐confirmed or suspected COVID‐19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first‐pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID‐19 negative and 329 confirmed or presumed COVID‐19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID‐19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70–4.10)). Children who had symptoms of COVID‐19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5–9.1)). Children with confirmed or presumed COVID‐19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.

SARS‐CoV‐2 airway reactivity in children: more of the same?

“…To answer this question at the time, members of the International Paediatric Difficult Intubation Collaborative network conducted a prospective multicentre study based on data collected via the paediatric airway complications during COVID‐19 (PAWS‐COVID‐19) collaboration registry. The resulting article [ 7 ], is a good example of an attempt to quickly collect as reliable data as possible to produce clinically useful results in the middle of a chaotic pandemic. The authors should be applauded for their efforts.…”

“…To minimise data collection errors, Peterson et al. [ 7 ] created a robust research collaboration and database structure. Other, ‘fruitful’ national and international success stories in paediatric anaesthesia have been reported over the past decade and continue to thrive (e.g.…”

“…Very few specific viruses have been studied for their individual airway risk properties or ranked against each other (e.g. is an adenovirus riskier than a rhinovirus infection when The resulting article [7], is a good example of an attempt to quickly collect as reliable data as possible to produce clinically useful results in the middle of a chaotic pandemic.…”

“…One of the strengths of large multicentre studies is also one of the potential weaknesses: how does one ensure standardised data collection when processing information from such a large and diverse group of institutions? To minimise data collection errors, Peterson et al[7] created a robust research collaboration and database structure. Other, `fruitful´national and international success stories in paediatric anaesthesia have been reported over the past decade and continue to thrive (e.g.…”

Postanesthesia complications in pediatric patients with previous SARS‐CoV‐2 infection: A cohort study

“…Increased risk is evident even if the patient is asymptomatic at the time of surgery, in both pediatric and adult studies 8,11 . A recent multicenter, international study found children with SARS‐CoV‐2 had a higher incidence of hypoxemia and overall complications during airway management for general anesthesia 15 . These results suggest that SARS‐CoV‐2 disease in children is clinically significant and support current ASA guidelines of delaying surgery if the procedure is not emergent, even if the patient is asymptomatic or their symptoms have resolved.…”