A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department

Abstract

Introduction Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution. Methods We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with physicians, nurses, and respiratory therapists, and incorporating their feedback into the development, we were able to optimize the process prior to implementation. Training sessions also enabled the participants to practice the algorithm as a team. Upon completion of each training session, participants were invited to complete a brief online survey about their overall experience. Results An algorithm and training system vetted by simulation and actual practice were developed. A training video and dissemination package were made available for other emergency departments to adopt. Survey results were overall positive, with 97.92% of participants feeling confident in their role in the intubation process, and many participants citing the usefulness of the multidisciplinary approach to the training. Conclusion A multidisciplinary, team-based approach to the development and training of a standardized intubation algorithm combining simulation and rapid-cycle improvement methodology is a useful, effective process to respond to rapidly evolving clinical information and experiences during a global pandemic.

Emergency Tracheal Intubation in Patients with COVID-19: A Single-center, Retrospective Cohort Study

“…We found increased utilization of video laryngoscopy in COVID-19 cases that is consistent with recent expert recommendations. 21 , 22 It is important to note that these guidelines were motivated by an effort to reduce provider infections by increasing distance between patient and operator rather than intubation performance. There is mixed evidence that video laryngoscopy results in decreased intubation attempts or reduced incidence of peri-intubation hypoxia.…”

Health Care Simulation as a Training Tool for Epidemic Management

“…The study characteristics are presented in the Table 1. Most of the studies on simulation-based training were developed in response to SARS-CoV-2 (n = 117, 79.1%) 6–8,16–128 . Eighteen were motivated by Ebola outbreaks (12.2%), 129–146 7 by influenza (4.7%), 147–153 3 by MERS (2%), 154–156 and 3 by pandemics in general (2%) 157–159 …”

Maintaining Prehospital Intubation Success with COVID-19 Personal Protective Precautions

“…The recommended use of VL in patients with suspected COVID-19 infection is in line with recent expert guidelines. [34][35][36] Expert consensus remains the basis for use of VL first line in patients with COVID-19 infection, as there is a paucity of high-quality evidence demonstrating superiority of VL in this prehospital and in-hospital patient group. 37,38 Most of the guidance for use of VL in COVID-19 patients suggests that the main reason to use VL rather than DL is to reduce provider infections by increasing the distance between patient and operator rather than to maintain intubation performance.…”