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

Abstract EN

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%, p=0.610) and lower first-pass success (0% vs.

92%, p<0.001).

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, p<0.001).

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.