LETTERS TO EDITOR
Year : 2022 | Volume
| Issue : 2 | Page : 251-252
Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry
Faisal Shamim1, Mohsin Nazir1, Naseem A Sheikh2, Asma Salam3, Badar Afzal4
1 Department of Anaesthesiology, The Aga Khan University, Karachi, Sindh, Pakistan
2 Department of Anesthesiology and Critical Care, Hameed Latif Hospital, Lahore, Punjab, India
3 Department of Anaesthesia, Dr. Ziauddin University and Hospital Clifton, Karachi, Sindh, Pakistan
4 Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
Department of Anaesthesiology, Aga Khan University Hospital, Stadium Road, P.O. Box - 3500, Karachi - 74800, Sindh
Source of Support: None, Conflict of Interest: None
|Date of Submission||19-Oct-2021|
|Date of Acceptance||24-Oct-2021|
|Date of Web Publication||17-Mar-2022|
|How to cite this article:|
Shamim F, Nazir M, Sheikh NA, Salam A, Afzal B. Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry. Saudi J Anaesth 2022;16:251-2
|How to cite this URL:|
Shamim F, Nazir M, Sheikh NA, Salam A, Afzal B. Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry. Saudi J Anaesth [serial online] 2022 [cited 2022 May 17];16:251-2. Available from: https://www.saudija.org/text.asp?2022/16/2/251/339855
To the Editor,
Airway management procedures are considered high risk for viral spread and may expose healthcare workers (HCWs) to coronavirus disease (COVID-19). Tracheal intubation in these patients poses a unique set of challenges, combining complex time-critical tasks in physiologically difficult airways. Despite many publications of protocols and guidelines, there was a dearth of evidence available describing the manner in which the COVID-19 pandemic changed the practice of emergency airway management, its outcomes, and associated complications. However, what is now known is that there are variabilities in practice across different settings and countries.
In March 2020, a prospective, international, multicentre cohort study, intubateCOVID was launched to gather information about HCWs involved in tracheal intubation of suspected or confirmed COVID-19 patients, with Pakistan becoming collaborating site in May 2020 [Supplementary Material S1]. Exemption from ethical approval for formal research was given by ethics review committee (ERC) of Aga Khan University on 24th May, 2020. The other two hospitals have also provided ethical approval/waiver from their respective ERC. Participants reported details of personal protective equipment, airway management procedure characteristics, health outcomes, and personnel involved. We present data from Pakistan from this international registry and discuss their implications. We restricted the present analysis to providers who recorded an airway procedure in which they directly performed an intubation.
Twenty HCWs from three hospitals recorded at least one tracheal intubation in a patient with COVID-19, and then reported their health outcomes. Between May 2020 and March 2021, 184 tracheal intubations in COVID patients were performed, of which 86% were males. The primary indication for tracheal intubation was deteriorating respiratory condition and 78% tracheal intubations were performed by anesthesiologist, followed by emergency medicine physicians (22%). [Table 1] summarizes the provider and airway procedure characteristics as frequencies.
|able 1: Characteristics and details of airway management in COVID-19 by participants from Pakistan in the intubateCOVID registry from May 2020 to March 2021 (n=184)|
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Videolaryngoscope was used for first attempt laryngoscopy in 112 (61%) patients while direct laryngoscopy (DL) was chosen in 71 (38.5%). There was a high first attempt success rate (89.6%). Increased number of DL using a Macintosh blade may be explained by unavailability of VL in early part of pandemic due to supply--demand disparity or its preference by some personnel. Only one patient required fiberoptic intubation who was confirmed COVID-19 positive. 141 (76.6%) intubations were performed by consultants while 39 (21.2%) by trainees, consistent with suggestions in guidelines for involving most senior airway manager. Adherence to WHO personal protective equipment standards were mostly observed in our data set. Also, presence of staff in the intubation room (3.1 ± 0.6) was also found in line with different societies recommendations for minimizing the number.
The mean (SD) age of HCWs reported their follow-up data, which was 34.5 (5). Laboratory confirmed PCR was reported by six participants (2.8%) and nine (4.2%) had to isolate themselves due to high risk exposure. Sore throat, cough, and fatigue were the most observed signs and symptoms.
This represents a small sample of registry data from a low-middle income country. Although the subset may not be truly reflective of airway management practices in COVID-19 on a larger scale, it still gives insight and comparison with other settings. Pakistan is facing fourth wave currently with the emergence of the delta variant of SARS-CoV-2 and being spread across country with positivity rate rose to 9% in August 2021. The findings and recommendations by intubateCOVID registry are valuable in guiding departmental/institutional policies for airway management.
Financial support and sponsorship
IntubateCOVID research project received financial support from the Difficult Airway Society (UK), the American Society of Anesthesiologists, the International Anesthesia Research Society and the Anesthesia Patient Safety Foundation.
Conflicts of interest
There are no conflicts of interest.
An electronic file is provided containing names of intubateCOVID Pakistan Collaborators and the intubateCOVID International Coordinating Centre.
| Supplementary Material S1|| |
intubateCOVID Pakistan collaborators*
Faisal Shamim, Mohsin Nazir, Muhammad Sohaib, Khalid Samad, Tanveer Baig, Saima Rashid, Shemila Abbasi, Ali Asghar, Asiyah Aman, Khalid Ahsan, Azhar Rehman, Samie Asghar Dogar, Shabbir Ahmed (Department of Anaesthesiology, Aga Khan University, Karachi), Badar Afzal (Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan), Asma Salam (Department of Anaesthesia, Ziauddin University, Dr Ziauddin Hospital Clifton, Karachi), Naseem Ali Sheikh (Anaesthesia and Critical Care, Hameed Latif Hospital, Lahore), Mujahid Ul Islam (Cardiothoracic Anesthesia, Rehman medical institute, Peshawar)
intubateCOVID International Coordinating Centre**
**intubateCOVID International Coordinating Centre: Danny J.N. Wong FRCA PhD, (Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK); Kariem El-Boghdadly FRCA MSc (Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK, and King's College London, UK); Craig Johnstone FRCA (Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK); Imran Ahmad FRCA (Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK, and King's College London, UK); Mark D Neuman MD (Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine)
| References|| |
El-Boghdadly K, Wong DJ, Owen R, Neuman MD, Pocock S, Carlisle JB, et al
. Risks to healthcare workers following tracheal intubation of patients with COVID-19: A prospective international multicentre cohort study. Anaesthesia 2020;75:1437-47.
Parotto M, Cavallin F, Bryson GL, Chin KJ, intubateCOVID Canadian collaborators, intubateCOVID Canadian collaborators and the intubateCOVID International Coordinating Centre. Risks to healthcare workers following tracheal intubation of patients with known or suspected COVID-19 in Canada: Data from the intubateCOVID registry. Can J Anaesth 2021;68:425-7.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785-99.
Brewster DJ, Chrimes N, Do TB, Fraser K, Groombridge CJ, Higgs A, et al
. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust 2020;212:472-81.
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