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

El‐Boghdadly, Kariem; Wong, D. J. N.; Owen, Ruth; Neuman, Mark D.; Pocock, Stuart J.; Carlisle, J. B.; Johnstone, Craig; Andruszkiewicz, Paweł; Baker, Paul; Biccard, Bruce; Bryson, Gregory L.; Chan, Matthew T. V.; Cheng, Ming Shien; Chin, Ki Jinn; Coburn, Mark; Fagerlund, Malin Jonsson; Myatra, Sheila Nainan; Myles, Paul S.; O’Sullivan, E.; Pasin, Laura; Shamim, Faisal; Klei, Wilton A. van; Ahmad, Imtiaz

doi:10.1111/anae.15170

Cited by 253 publications

(309 citation statements)

References 18 publications

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“…When each contact with a patient becomes a potential health risk, supervised procedures performed by a trainee may seem unnecessary. Aerosol-generating procedures such as bag and mask ventilation, tracheal intubation, and tracheostomy appear to carry the greatest risks, 3 and there is understandable pressure for the most experienced practitioner to perform the procedure swiftly and efficiently. This diminishes the experience gained by the trainee and the opportunity to be signed off for a workplace-based assessment.…”

Section: Clinical Teachingmentioning

confidence: 99%

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

Sneyd

Mathoulin

O’Sullivan

et al. 2020

British Journal of Anaesthesia

111

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Coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has dislocated clinical services and postgraduate training. To better understand and to document these impacts, we contacted anaesthesia trainees and trainers across six continents and collated their experiences during the pandemic. All aspects of training programmes have been affected. Trainees report that reduced caseload, sub-specialty experience, and supervised procedures are impairing learning. Cancelled educational activities, postponed examinations, and altered rotations threaten progression through training. Job prospects and international opportunities are downgraded. Workrelated anxieties about provision of personal protective equipment, and risks to self and to colleagues are superimposed on concerns for family and friends and domestic disruption. These seismic changes have had consequences for wellbeing and mental health. In response, anaesthetists have developed innovations in teaching and trainee support. New technologies support traineretrainee interactions, with a focus on e-learning. National training bodies and medical regulators that specify training and oversee assessment of trainees and their progression have provided flexibility in their requirements. Within anaesthesia departments, support transcends grades and job titles with lessons for the future. Attention to wellness, awareness of mental health issues and multimodal support can attenuate but not eliminate trainee distress.

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Section: Clinical Teachingmentioning

confidence: 99%

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

Sneyd

Mathoulin

O’Sullivan

et al. 2020

British Journal of Anaesthesia

111

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“…El-Boghdadly et al found that approximately one in ten healthcare workers involved in tracheal intubation of patients with or suspected of COVID-19 subsequently reported symptoms or laboratory-confirmed COVID-19 diagnosis. 15 That study reported 5,148 intubation episodes across 17 countries involving assistants and intubators and acknowledge that the exposure source may not just be attributed to the tracheal intubation episode. Despite our MERIT members being exposed to multiple intubations, the rate of healthcare workers self-isolating because of suspected or confirmed COVID-19 is similar to that reported by El-Boghdadly et al That said, the utilization of adequate PPE was greater in this current study compared with the data presented by El-Boghdadly et al; thus, one might expect the rates of COVID-19 transmission to healthcare workers to be lower in our institutional cohort.…”

Section: Discussionmentioning

confidence: 99%

“…MERIT was designed to be a self-sufficient, rapidly mobile team, thus all team members had their own PPE available for every airway procedure they attended, including fit-tested FFP3 respirators, visors, long-sleeved gowns, and gloves. 14 A single-use videolaryngoscope was the tracheal intubation device of choice, 15 and included either the iview videolaryngoscope (Intersurgical Ltd., Wokingham, UK) or the AirtraqÒ (Fannin, Dublin, Ireland). The videolaryngoscope was chosen because it potentially reduces the time to tracheal intubation, improves the first pass success rate, allows all team members to observe the laryngoscopic view, and increases the distance between the laryngoscopist and patient thereby reducing the risk of aerosol or droplet exposure.…”

Section: Methodsmentioning

confidence: 99%

“…Au total, 91,3 % des intubations trache´ales ont e´teŕ e´alise´es par vide´olaryngoscopie, et le taux de re´ussite au premier essai e´tait de 88,0 %. Le taux de survie a`30 jours e´tait de 69,2 %, et la dure´e médiane (e´cart interquartile) de se´jour aux soins intensifs e´tait de 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) jours et de 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) jours a`l'hôpital. Sept (11,1 %) professionnels de la sante´de l'e´quipe MERIT se sont mis en auto-isolement en raison de symptômes de la COVID-19, pour un total de 41 jours de travail clinique perdus.…”

Section: Résuméunclassified

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A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams

Ahmad

Jeyarajah

Nair

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Because of the anticipated surge in cases requiring intensive care unit admission, the high aerosolgenerating risk of tracheal intubation, and the specific requirements in coronavirus disease (COVID-19) patients, a dedicated Mobile Endotracheal Rapid Intubation Team (MERIT) was formed to ensure that a highly skilled team would be deployed to manage the airways of this cohort of patients. Here, we report our intubation team experience and activity as well as patient outcomes during the COVID-19 pandemic. Methods The MERIT members followed a protocolized early tracheal intubation model. Over a seven-week period during the peak of the pandemic, prospective data were collected on MERIT activity, COVID-19 symptoms or diagnosis in the team members, and demographic, procedural, and clinical outcomes of patients. Results We analyzed data from 150 primary tracheal intubation episodes, with 101 (67.3%) of those occurring in men, and with a mean (standard deviation) age of 55.7 (13.8) yr. Black, Asian, and minority ethnic groups accounted for 55.7% of patients. 91.3% of tracheal intubations were performed with videolaryngoscopy, and the first pass success rate was 88.0%. The 30-day survival was 69.2%, and the median [interquartile range] length of critical care stay was 11 [6-20] days and of hospital stay was 12 [7-22] days. Seven (11.1%) MERIT healthcare professionals self-isolated because of COVID-19 symptoms, with a total 41 days of clinical work lost. There was one reported incident of a breach of personal protective equipment and multiple anecdotal reports of doffing breaches. Conclusion We have shown that a highly skilled designated intubation team, following a protocolized, early tracheal intubation model may be beneficial in improving patient and staff safety, and could be considered by other institutions in future pandemic surges.

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“…Up to 11 May 2020, 203 healthcare worker deaths had been reported in the UK [3]. Whilst none of these were anaesthetists or intensivists, 53 out of 1718 (3.1%) healthcare workers performing or involved in tracheal intubation of patients with confirmed or suspected COVID‐19 subsequently reported laboratory‐confirmed SARS‐CoV‐2 infection [4].…”

Section: Introductionmentioning

confidence: 99%

Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri‐operative care: a narrative review

2020

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Summary The protection of healthcare workers from the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is a paramount concern. SARS‐CoV‐2 is likely to remain endemic and measures to protect healthcare workers against nosocomial infection will need to be maintained. This review aims to inform the assessment and management of the risk of SARS‐CoV‐2 transmission to healthcare workers involved in elective peri‐operative care. In the absence of data specifically related to the risk of SARS‐CoV‐2 transmission in the peri‐operative setting, we explore the evidence‐base that exists regarding modes of viral transmission, historical evidence for the risk associated with aerosol‐generating procedures and contemporaneous data from the COVID‐19 pandemic. We identify a significant lack of data regarding the risk of transmission in the management of elective surgical patients, highlighting the urgent need for further research.

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

Cited by 253 publications

References 18 publications

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams

Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri‐operative care: a narrative review

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