Emergency airway management in a tertiary trauma centre (AIRMAN): a one-year prospective longitudinal study

Hall, Thomas J.; Leeies, Murdoch; Funk, Duane J.; Hrymak, Carmen; Siddiqui, Faisal; Black, Holly; Webster, Kim; Tkach, Jenn; Waskin, Matt; Dufault, Brenden; Kowalski, Stephen

doi:10.1007/s12630-022-02390-2

Cited by 3 publications

(1 citation statement)

References 27 publications

(45 reference statements)

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“…In a subgroup analysis, we examined the grade-specific FPS of intubators. During the pre-pandemic period, junior (PGY1) emergency physicians had a particularly low overall FPS compared with senior Emergency physicians, which is consistent with the findings of other studies [39][40][41]. In this study, the FPS rate for junior emergency physicians during the pandemic was 85.5%, which was not significantly lower than in the pre-pandemic period.…”

Section: Discussionsupporting

confidence: 90%

Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study

Jang

Kang

Shin

et al. 2023

JPM

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Aerosols and droplets have put healthcare workers performing airway management at high risk of contracting coronavirus disease 2019 (COVID-19). Experts have developed endotracheal intubation (ETI) guidelines and protocols to protect intubators from infection. We aimed to determine whether changes in the emergency department (ED) intubation protocol to prevent COVID-19 infection were associated with first-pass success (FPS) rates in ETI. We used data from the airway management registries in two academic EDs. The study was divided into pre-pandemic (January 2018 to January 2020) and pandemic (February 2020 to February 2022) periods. We selected 2476 intubation cases, including 1151 and 1325 cases recorded before and during the pandemic, respectively. During the pandemic, the FPS rate was 92.2%, which did not change significantly, and major complications increased slightly but not significantly compared with the pre-pandemic period. The OR for the FPS of applying infection prevention intubation protocols was 0.72 (p = 0.069) in a subgroup analysis, junior emergency physicians (PGY1 residents) had an FPS of less than 80% regardless of pandemic protocol implementation. The FPS rate of senior emergency physicians in physiologically difficult airways decreased significantly during the pandemic (98.0% to 88.5%). In conclusion, the FPS rate and complications for adult ETI performed by emergency physicians using COVID-19 infection prevention intubation protocols were similar to pre-pandemic conditions.

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Section: Discussionsupporting

confidence: 90%

Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study

Jang

Kang

Shin

et al. 2023

JPM

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Management of the Traumatized Airway

Dave,

Romito,

Karamchandani

2024

Curr Anesthesiol Rep

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A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic

et al. 2022

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Objective Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba’s largest tertiary hospital. During this study, a natural experiment emerged when a standardized “COVID-Protected Rapid Sequence Intubation Protocol” was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a “COVID-Protected Rapid Sequence Intubation Protocol” impact first-pass success or other intubation-related outcomes? Methods A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack–Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days. Results Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% ( n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% ( n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack–Lehane view favoring the protocol ( p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol ( p = 0.0172). Conclusion A “COVID-Protected Protocol” implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00422-w.

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Emergency airway management in a tertiary trauma centre (AIRMAN): a one-year prospective longitudinal study

Cited by 3 publications

References 27 publications

Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study

Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study

Management of the Traumatized Airway

A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic

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