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Unintended consequences: The impact of airway management modifications introduced in response to COVID-19 on intubations in a tertiary centre emergency department.
Groombridge, Christopher J; Maini, Amit; Olaussen, Alexander; Kim, Yesul; Fitzgerald, Mark; Smit, De Villiers.
Afiliação
  • Groombridge CJ; National Trauma Research Institute, Melbourne, Victoria, Australia.
  • Maini A; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
  • Olaussen A; Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
  • Kim Y; National Trauma Research Institute, Melbourne, Victoria, Australia.
  • Fitzgerald M; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
  • Smit V; National Trauma Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas ; 33(4): 728-733, 2021 08.
Article em En | MEDLINE | ID: mdl-34080299
OBJECTIVE: In response to COVID-19, we introduced and examined the effect of a raft of modifications to standard practice on adverse events and first-attempt success (FAS) associated with ED intubation. METHODS: An analysis of prospectively collected registry data of all ED intubations over a 3-year period at an Australian Major Trauma Centre. During the first 6 months of the COVID-19 pandemic in Australia, we introduced modifications to standard practice to reduce the risk to staff including: aerosolisation reduction, comprehensive personal protective equipment for all intubations, regular low fidelity simulation with 'sign-off' for all medical and nursing staff, senior clinician laryngoscopist and the introduction of pre-drawn medications. RESULTS: There were 783 patients, 136 in the COVID-19 era and 647 in the pre-COVID-19 comparator group. The rate of hypoxia was higher during the COVID-19 era compared to pre-COVID-19 (18.4% vs 9.6%, P < 0.005). This occurred despite the FAS rate remaining very high (95.6% vs 93.8%, P = 0.42) and intubation being undertaken by more senior laryngoscopists (consultant 55.9% during COVID-19 vs 22.6% pre-COVID-19, P < 0.001). Other adverse events were similar before and during COVID-19 (hypotension 12.5% vs 7.9%, P = 0.082; bradycardia 1.5% vs 0.5%, P = 0.21). Video laryngoscopy was more likely to be used during COVID-19 (95.6% vs 82.5%, P < 0.001) and induction of anaesthesia more often used ketamine (66.9% vs 42.3%, P < 0.001) and rocuronium (86.8% vs 52.1%, P < 0.001). CONCLUSIONS: This raft of modifications to ED intubation was associated with significant increase in hypoxia despite a very high FAS rate and more senior first laryngoscopist.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Manuseio das Vias Aéreas / COVID-19 / Intubação Intratraqueal Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: Oceania Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Manuseio das Vias Aéreas / COVID-19 / Intubação Intratraqueal Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: Oceania Idioma: En Ano de publicação: 2021 Tipo de documento: Article