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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2023

Open Access 01-12-2023 | COVID-19 | Research

Characterizing intubation practices in response to the COVID-19 pandemic: a survey of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) sites

Authors: Muzeen Ismath, Holly Black, Carmen Hrymak, Rhonda J. Rosychuk, Patrick Archambault, Patrick T. Fok, Thomas Audet, Brenden Dufault, Corinne Hohl, Murdoch Leeies

Published in: BMC Emergency Medicine | Issue 1/2023

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Abstract

Objective

The risk of occupational exposure during endotracheal intubation has required the global Emergency Medicine (EM), Anesthesia, and Critical Care communities to institute new COVID- protected intubation guidelines, checklists, and protocols. This survey aimed to deepen the understanding of the changes in intubation practices across Canada by evaluating the pre-COVID-19, early-COVID-19, and present-day periods, elucidating facilitators and barriers to implementation, and understanding provider impressions of the effectiveness and safety of the changes made.

Methods

We conducted an electronic, self-administered, cross-sectional survey of EM physician site leads within the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) to characterize and compare airway management practices in the pre-COVID-19, early-COVID-19, and present-day periods. Ethics approval for this study was obtained from the University of Manitoba Health Research Ethics Board. The electronic platform SurveyMonkey (www.​surveymonkey.​com) was used to collect and store survey tool responses. Categorical item responses, including the primary outcome, are reported as numbers and proportions. Variations in intubation practices over time were evaluated through mixed-effects logistic regression models.

Results

Invitations were sent to 33 emergency department (ED) physician site leads in the CCEDRRN. We collected 27 survey responses, 4 were excluded, and 23 analysed. Responses were collected in English (87%) and French (13%), from across Canada and included mainly physicians practicing in mainly Academic and tertiary sites (83%). All respondents reported that the intubation protocols used in their EDs changed in response to the COVID-19 pandemic (100%, n = 23, 95% CI 0.86-1.00).

Conclusions

This study provides a novel summary of changes to airway management practices in response to the evolving COVID-19 pandemic in Canada. Information from this study could help inform a consensus on safe and effective emergent intubation of persons with communicable respiratory infections in the future.
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Literature
1.
Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J et al. Infectious Diseases society of America guidelines on Infection prevention for healthcare personnel caring for patients with suspected or known coronavirus Disease 2019. Clin Infect Dis. 2020.
2.
Kovacs G, Sowers N, Campbell S, French J, Atkinson P. Just the facts: airway management during the coronavirus Disease 2019 (COVID-19) pandemic. Can J Emerg Med. 2020;22(4):440–4.CrossRef
3.
Huang J, Zeng J, Xie M, Huang X, Wei X, Pan L. How to perform tracheal intubation for COVID-19 patients safely and effectively: experience AND tips from Sichuan, China. J Clin Anesth. 2020;64:109800.CrossRefPubMedPubMedCentral
4.
Herman JA, Urits I, Kaye AD, Urman RD, Viswanath O. COVID-19: anesthesia management recommendations. J Clin Anesth. 2020.
5.
Kluge S, Janssens U, Welte T, Weber-Carstens S, Marx G, Karagiannidis C. German recommendations for critically ill patients with COVID-19. Medizinische Klinik-Intensivmedizin und Notfallmedizin. 2020;115(3):111–4.CrossRefPubMed
6.
Zhang L, Li J, Zhou M, Chen Z. Summary of 20 tracheal intubation by anesthesiologists for patients with severe COVID-19 Pneumonia: retrospective case series. J Anesth. 2020;34(4):599–606.CrossRefPubMedPubMedCentral
7.
Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesthesia/Journal Canadien d’anesthésie. 2020;67(5):568–76.CrossRef
8.
Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth. 2020;125(1):e28–e37.CrossRefPubMed
9.
Cubillos J, Querney J, Rankin A, Moore J, Armstrong K. A multipurpose portable negative air flow isolation chamber for aerosol-generating procedures during the COVID-19 pandemic. Br J Anaesth. 2020;125(1):e179–81.CrossRefPubMed
10.
Lin LW, Hung TY. Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19. Emerg Med J. 2020;37(5):256–7.PubMed
11.
Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10(1):1–3.CrossRef
12.
Sorbello M, Rosenblatt W, Hofmeyr R, Greif R, Urdaneta F. Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. Br J Anaesth. 2020;125(6):880–94.CrossRefPubMed
13.
Tsang K, Mertz D, Chagla Z, Smaill F, Khan S. 492. Canadian consensus of COVID-19 policy and management aspects. In: Open Forum Infectious Diseases. 2020. p. S312–S313.
14.
Murdoch Leeies RJ, Rosychuk M, Ismath K, Xu P, Archambault PT, Fok et al. Intubation practices and outcomes for patients with suspected or confirmed COVID-19: a national observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Accepted for publication.
15.
Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ. 2008;179(3):245–52.CrossRefPubMedPubMedCentral
16.
Dillman DA, Smyth JD, Christian LM. Internet, phone, mail, and mixed-mode surveys: the tailored design method. John Wiley & Sons; 2014.
17.
Byers JF, White S. v. Patient safety: principles and practice: springer publishing company. 2004.
18.
Hohl CM, Rosychuk RJ, McRae AD, Brooks SC, Archambault P, Fok PT, et al. Development of the Canadian COVID-19 Emergency Department Rapid Response Network population-based registry: a methodology study. Can Med Association Open Access J. 2021;9(1):E261–70.
19.
Leeies M, Gershengorn HB, Charbonney E, Kumar A, Fergusson D, Turgeon AF, et al. Intravenous immune globulin in septic shock: a Canadian national survey of critical care medicine and Infectious Disease specialist physicians. Can J Anesthesia/Journal Canadien d’anesthésie. 2021;68(6):782–90.CrossRef
20.
Asch ’DA, Kathryn Jedrziewski M. Christakis3 ~ 4 ~ NA. Response rates to mail surveys published in medical journals. J Cl i n Epidemlol. 1997;50(10):1129–36.CrossRef
21.
Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35(6):1347.PubMedPubMedCentral
22.
Wu CN, Xia LZ, Li KH, Ma WH, Yu DN, Qu B, et al. High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 Pneumonia: a prospective randomised controlled trial. Br J Anaesth. 2020;125(1):e166–8.CrossRefPubMed
23.
Lockhart SL, Duggan Lv, Wax RS, Saad S, Grocott HP. Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic. Can J Anesthesia/Journal Canadien d’anesthésie. 2020;67(8):1005–15.CrossRef
24.
Mark L, Lester L, Cover R, Herzer K. A decade of difficult airway response team: lessons learned from a hospital-wide difficult airway response team program. Crit Care Clin. 2018;34(2):239–51.CrossRefPubMed
25.
Tankard KA, Sharifpour M, Chang MG, Bittner EA. Design and Implementation of Airway Response Teams to improve the Practice of Emergency Airway Management. J Clin Med. 2022;11(21):6336.CrossRefPubMedPubMedCentral
26.
Henderson SO, McClung CD, Sintuu C, Swadron SP. The presence of an Emergency Airway Response Team and its effects on in-hospital code Blue. J Emerg Med. 2009;36(2):116–20.CrossRefPubMed
27.
Magor K, Chhina T, Cacic I, Wong BI, el Beheiry H. Performance and impact of an airway management team launched during the COVID-19 pandemic. Can J Anaesthesia/Journal Canadien d’anesthésie. 2022;69(2):205–15.CrossRef
28.
Jarvis N, Schiavo S, Bartoszko J, Ma M, Chin KJ, Parotto M. A specialized airway management team for COVID-19 patients: a retrospective study of the experience of two Canadian hospitals in Toronto. Can J Anesthesia/Journal Canadien d’anesthésie. 2022;69(3):333–42.CrossRef
29.
Ahmad I, Jeyarajah J, Nair G, Ragbourne SC, Vowles B, Wong DJN, et al. A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams. Can J Anesthesia/Journal Canadien d’anesthésie. 2021;68(2):196–203.CrossRef
30.
Griesdale DEG, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34(10):1835–42.CrossRefPubMed
31.
Jung W, Kim J. Factors associated with first-pass success of emergency endotracheal intubation. Am J Emerg Med. 2020;38(1):109–13.CrossRefPubMed
32.
Laloo R, Santhosh Karri R, Wanigasooriya K, Beedham W, Darr A, Layton GR, et al. The perceived global impact of the COVID-19 pandemic on doctors’ medical and surgical training: an international survey. Int J Clin Pract. 2021;75(8):e14314.CrossRefPubMed
33.
Brown CA III, Bair AE, Pallin DJ, Laurin EG, Walls RM, Investigators NEAR (NEAR), editors. Improved glottic exposure with the Video Macintosh Laryngoscope in adult emergency department tracheal intubations. Ann Emerg Med. 2010;56(2):83–8.
34.
Michailidou M, O’Keeffe T, Mosier JM, Friese RS, Joseph B, Rhee P, et al. A comparison of video laryngoscopy to direct laryngoscopy for the emergency intubation of trauma patients. World J Surg. 2015;39(3):782–8.CrossRefPubMed
35.
Brown CA III, Kaji AH, Fantegrossi A, Carlson JN, April MD, Kilgo RW, et al. Video laryngoscopy compared to augmented direct laryngoscopy in adult emergency department tracheal intubations: a National Emergency Airway Registry (NEAR) study. Acad Emerg Med. 2020;27(2):100–8.CrossRefPubMed
36.
Hypes CD, Stolz U, Sakles JC, Joshi RR, Natt B, Malo J, et al. Video laryngoscopy improves odds of first-attempt success at intubation in the intensive care unit. A propensity-matched analysis. Ann Am Thorac Soc. 2016;13(3):382–90.CrossRefPubMed
37.
Lundstrøm LH, Duez CH v, Nørskov AK, Rosenstock C, v, Thomsen JL, Møller AM, et al. Effects of avoidance or use of neuromuscular blocking agents on outcomes in tracheal intubation: a Cochrane systematic review. Br J Anaesth. 2018;120(6):1381–93.CrossRefPubMed
38.
Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NTP, Dhillon A, et al. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related Complications. Crit Care Med. 2012;40(6):1808–13.CrossRefPubMed
39.
Soh M, Hifumi T, Otani N, Maki K, Hayashi M, Miyazaki M, et al. Trends in endotracheal intubation for patients with COVID-19 by emergency physicians. Glob Health Med. 2022;4(2):116–21.CrossRefPubMedPubMedCentral
40.
Cheung JCH, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med. 2020;8(4):e19.CrossRefPubMedPubMedCentral
41.
Larsson A, Dhonneur G. Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU? Intensive Care Medicine. Springer; 2013;39:2220–2.
42.
Black H, Hall T, Hrymak C, Funk D, Siddiqui F, Sokal J et al. A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic. Can J Emerg Med. 2022;1–11.
Metadata
Title
Characterizing intubation practices in response to the COVID-19 pandemic: a survey of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) sites
Authors
Muzeen Ismath
Holly Black
Carmen Hrymak
Rhonda J. Rosychuk
Patrick Archambault
Patrick T. Fok
Thomas Audet
Brenden Dufault
Corinne Hohl
Murdoch Leeies
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2023
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-023-00911-w

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