• Christopher J Groombridge, Amit Maini, Alexander Olaussen, Yesul Kim, Mark Fitzgerald, and SmitDe VilliersVNational Trauma Research Institute, Melbourne, Victoria, Australia.Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Au.
• National Trauma Research Institute, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2021 Aug 1; 33 (4): 728-733.

ObjectiveIn 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.MethodsAn 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.ResultsThere 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).ConclusionsThis raft of modifications to ED intubation was associated with significant increase in hypoxia despite a very high FAS rate and more senior first laryngoscopist.© 2021 Australasian College for Emergency Medicine.

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