Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre

Gandhi, Ajay; Sokhi, Jagdish; Lockie, Chris; Ward, Patrick A.

doi:https://doi.org/10.1155/2020/8816729

Anesthesiology Research and Practice

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Research Article | Open Access

Volume 2020 | Article ID 8816729 | https://doi.org/10.1155/2020/8816729

Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre

Ajay Gandhi,¹Jagdish Sokhi,¹Chris Lockie,¹and Patrick A. Ward¹

Academic Editor: Ronald G. Pearl

Received08 Sept 2020

Revised06 Nov 2020

Accepted23 Nov 2020

Published10 Dec 2020

Abstract

This retrospective observational case series describes a single centre’s preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, ) and lower first-pass success (0% vs. 92%, ). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, ). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)—specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.

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Copyright

Copyright © 2020 Ajay Gandhi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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