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Maintaining Prehospital Intubation Success with COVID-19 Personal Protective Precautions

Published online by Cambridge University Press:  12 September 2022

Pascale Avery Open the ORCID record for Pascale Avery [Opens in a new window] ,
Sam McAleer ,
David Rawlinson ,
Stuart Gill  and
David Lockey
Pascale Avery*
Affiliation:
Emergency Retrieval and Transfer Service (EMRTS) Wales Air Ambulance, Llanelli Gate, Dafen, Wales, United Kingdom
Sam McAleer
Affiliation:
Emergency Retrieval and Transfer Service (EMRTS) Wales Air Ambulance, Llanelli Gate, Dafen, Wales, United Kingdom
David Rawlinson
Affiliation:
Emergency Retrieval and Transfer Service (EMRTS) Wales Air Ambulance, Llanelli Gate, Dafen, Wales, United Kingdom
Stuart Gill
Affiliation:
Emergency Retrieval and Transfer Service (EMRTS) Wales Air Ambulance, Llanelli Gate, Dafen, Wales, United Kingdom
David Lockey
Affiliation:
Emergency Retrieval and Transfer Service (EMRTS) Wales Air Ambulance, Llanelli Gate, Dafen, Wales, United Kingdom
*
Correspondence: Pascale Avery, BMBS, MSc, FHEA, MRCEM Emergency Medical Retrieval and Transfer Service (EMRTS Cymru) - EMRTS Llanelli Gate, Wales Air Ambulance Charity, Ffordd Angel Dafen, Llanelli SA14 8LQ, United Kingdom E-mail: pascale.avery@nhs.net
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Abstract

Background:

Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP.

Methodology:

A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE – this date is used to separate the cohort groups.

Results:

Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251.

Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001).

Conclusion:

This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation.

Keywords

apneic oxygenationCOVID-19emergency anesthesiarapid sequence inductionstandard operating proceduresvideo laryngoscopy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 6 , December 2022 , pp. 783 - 787
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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