Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

Abstract

Introduction This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID‐19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. Main recommendations Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the “can't intubate, can't oxygenate” scenario. They should be followed where they do not contradict our specific recommendations for the COVID‐19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID‐19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID‐19 patient group. The principles for airway management should be the same for all patients with COVID‐19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID‐19. Changes in management as a result of this statement Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID‐19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.

Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic

“…The British Society of Gastroenterology believes that upper gastrointestinal endoscopy of all kinds must be regarded as an aerosol‐prone procedure. The Safe Airway Society of Australia and New Zealand classifies gastroscopy as a procedure vulnerable to aerosol generation 47 . This sentiment is echoed in a handbook based on clinical experience from China 31 .…”

Plastic Surgeons and COVID-19 Pandemic

“…• Minimizing the personnel inside OT during intubation, extubation, and tracheostomy. 29 • While using an operating microscope, keep the maximum part of the microscope covered with adhesive sterile disposable sheets.…”

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

“…In the light of our nding that an early intubation strategy might not be associated with increased mortality and morbidity, one could advocate this approach when taking into consideration its potential bene t of reduced viral aerosolization. To this end, several societies indeed recommend early intubation and avoidance of prolonged use of high-ow nasal oxygen and non-invasive mechanical ventilation in the era of COVID-19 [14].…”