Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic

Abstract

Introduction Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management. Materials and methods An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021. Results Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use. Conclusion Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.

Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic

“…The results of the INTUBE study (17% videolaryngoscope use) 28 support the initial low baseline, but the relatively small absolute increase at the point of survey completion is surprising. It is, however, mirrored in the Croatian institutional survey of videolaryngoscope use during the pandemic, where routine videolaryngoscope use rose from 16% to 21% on COVID wards, 29 and the survey of EAMS (European Airway Management Society) members which reported an increase in routine use of 12.5% to 38.9%. 25 Conversely, Granell Gil et al's survey of 1125 Spanish clinicians in the early phase of the pandemic (April/May 2020) reported that 70.5% of respondents would choose a videolaryngoscope to intubate COVID-19 patients.…”