scholarly journals Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study

2021 ◽  
Author(s):  
Danny J. N. Wong ◽  
Kariem El-Boghdadly ◽  
Ruth Owen ◽  
Craig Johnstone ◽  
Mark D. Neuman ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Rapid Sequence Induction ◽  
Middle Income ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Sequence Induction

Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results Successful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported—an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non–rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P = 0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P = 0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P = 0.001). Conclusions The authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Airway assessment and management

2021 ◽  
pp. 361-404
Author(s):  
Jules Cranshaw ◽  
Emira Kursumovic ◽  
Tim Cook
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Intubation ◽  
Rapid Sequence Induction ◽  
Respiratory Viruses ◽  
Airway Assessment ◽  
Rapid Sequence ◽  
Sequence Induction ◽  
Practical Information ◽  
Apnoeic Oxygenation

This chapter provides detailed, practical and up-to-date information on management of the airway. It demystifies airway terminology, outlines airway assessment, and describes the management of the unanticipated difficult airway in adults. It includes a new section on intubating critically ill patients using the vortex approach, and outlines the equipment and techniques used to aid airway management. It gives practical information on the emergency front of neck airway and strategies to approach the obstructed airway. It explains rapid sequence induction, inhalational induction, awake tracheal intubation, and extubation after difficult intubation. It contains new sections on apnoeic oxygenation and how to manage patients with airborne respiratory viruses.

scholarly journals Developing a simulation programme to train airway management during the COVID-19 pandemic in a tertiary-level hospital

2021 ◽  
pp. bmjstel-2020-000755
Author(s):  
Heung Yan Wong ◽  
Craig Johnstone ◽  
Gunjeet Dua
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Response Team ◽  
Operating Theatres ◽  
Invaluable Tool ◽  
Airway Response ◽  
Sequence Induction ◽  
Set Up

Tracheal intubation of a patient with COVID-19 is a high-risk procedure for not only the patient, but all healthcare workers involved, leading to an understandable degree of staff anxiety. We used simulation to help train airway managers to intubate patients with COVID-19. Based on action cards developed by our department, we designed a series of scenarios to simulate airway management during the COVID-19 pandemic. Teams were asked to perform a rapid sequence induction with tracheal intubation. We designed in situ scenarios with low-fidelity manikins that could be set up in operating theatres across multiple sites. Over a period of 4 weeks, 101 consultant anaesthetists, 58 anaesthetic trainees and 30 operating department practitioners received intubation training. These members made up the airway response team of our hospital. 30 emergency department doctors also received training in anticipation of further COVID-19 surges leading to the possibility of overwhelmed services. Simulation-based training was an invaluable tool for our hospital to rapidly upskill medical professionals during the first wave of the COVID-19 pandemic. We have used feedback and additional guidelines to improve our scenarios to retrain staff during subsequent waves.

scholarly journals Emergency airway management in a Singapore centre: A registry study

2021 ◽  
Vol 50 (1) ◽  
pp. 42-51
Author(s):  
Gene Wai Han Chan ◽  
Chew Yian Chai ◽  
Joy Su-Yue Teo ◽  
Calvin Kai En Tjio ◽  
Mui Teng Chua ◽  
...  
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Difficult Airway ◽  
Rapid Sequence Induction ◽  
University Hospital ◽  
Rapid Sequence Intubation ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Medical Indications

ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians’ initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction

Laryngeal morbidity and quality of tracheal intubation following rapid-sequence induction: comparison of succinylcholine and rocuronium

2004 ◽  
Vol 21 (Supplement 32) ◽  
pp. 141
Author(s):  
T. Mencke ◽  
M. Werth ◽  
H. Knoll ◽  
J.-U. Schreiber ◽  
C. Stracke ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Sequence Induction

scholarly journals Controversies in Pediatric Perioperative Airways

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Jozef Klučka ◽  
Petr Štourač ◽  
Roman Štoudek ◽  
Michaela Ťoukálková ◽  
Hana Harazim ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Relevant Literature ◽  
Rapid Sequence Induction ◽  
Pediatric Anesthesia ◽  
Related Complication ◽  
Pediatric Airway ◽  
Anesthesia Practice ◽  
Rapid Sequence ◽  
Sequence Induction

Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.

scholarly journals Mask ventilation

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1683
Author(s):  
Paul Baker
Keyword(s):  
Tracheal Intubation ◽  
Muscle Relaxation ◽  
Rapid Sequence Induction ◽  
Loss Of Consciousness ◽  
Mask Ventilation ◽  
Safe Patient Care ◽  
Rapid Sequence ◽  
Ventilation Technique ◽  
Sequence Induction ◽  
Effective Ventilation

Effective mask ventilation is an essential skill for any practitioner engaged in airway management. Recent methods to objectively describe mask ventilation using waveform capnography help practitioners to monitor and communicate the effectiveness of mask ventilation. Gentle mask ventilation is now considered acceptable during rapid sequence induction/intubation after loss of consciousness, hence reducing the incidence of hypoxia prior to tracheal intubation. Mask ventilation can be enhanced with muscle relaxation, a double C-E grip, and jaw thrust. This is particularly relevant for patients with reduced apnoea time. An awareness of the complications associated with mask ventilation may help reduce the morbidity associated with this technique. Effective ventilation technique and optimum device selection are important aspects for resuscitation of the newborn. Teaching correct establishment and maintenance of mask ventilation is essential for safe patient care. This review will examine some of the latest developments concerning mask ventilation for adult and paediatric patients.

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