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. 2023 Nov 24;23(1):139.
doi: 10.1186/s12873-023-00911-w.

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

Muzeen Ismath  1 , Holly Black  1 , Carmen Hrymak  1   2 , Rhonda J Rosychuk  3 , Patrick Archambault  4 , Patrick T Fok  5 , Thomas Audet  6 , Brenden Dufault  2   7 , Corinne Hohl  8 , Murdoch Leeies  9   10
Affiliations

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

Muzeen Ismath et al. BMC Emerg Med. .

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.

Keywords: COVID; COVID-19; Clinical simulation; Emergency airway management; Emergency intubation; In situ simulation; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survey response flow diagram
Fig. 2
Fig. 2
Intubator role over time
Fig. 3
Fig. 3
Variation in pre-oxygenation modalities over time PEEP: positive end-expiratory pressure, BiPAP: Bi-level positive airway pressure
Fig. 4
Fig. 4
Variation in laryngoscopy/bougie use over time Respondents were able to select multiple options
Fig. 5
Fig. 5
Oxygenation thresholds for intubation over time O2: oxygen; FiO2: fraction of inspired oxygen; BiPAP: bi-level positive airway pressure
See this image and copyright information in PMC

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