Anaesthesia Risks to Healthcare Workers Following Tracheal Intubation of Patients With COVID-19: A Prospective International Multicentre Cohort Study

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Anaesthesia


. 2020 Jun 9.
doi: 10.1111/anae.15170. Online ahead of print.
Risks to Healthcare Workers Following Tracheal Intubation of Patients With COVID-19: A Prospective International Multicentre Cohort Study


K El-Boghdadly ^{1 2} , D J N Wong ³ , R Owen ⁴ , M D Neuman ⁵ , S Pocock ⁶ , J B Carlisle ⁷ , C Johnstone ¹ , P Andruszkiewicz ⁸ , P A Baker ⁹ , B M Biccard ¹⁰ , G L Bryson ¹¹ , M T V Chan ¹² , M H Cheng ¹³ , K J Chin ¹⁴ , M Coburn ¹⁵ , M J Fagerlund ¹⁶ , S N Myatra ¹⁷ , P S Myles ¹⁸ , E O'Sullivan ¹⁹ , L Pasin ²⁰ , F Shamim ²¹ , W A van Klei ²² , I Ahmad ^{1 2}



Affiliations

• PMID: 32516833
• DOI: 10.1111/anae.15170

Abstract

Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use, and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors, and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1%, and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in females, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.

Keywords: COVID-19; airway; coronavirus; healthcare workers; intubation.