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Airway - Intubation (COVID-19)

Managing the airway of a patient with COVID-19 is a high-risk procedure with potential to transmit COVID-19 via contact, droplet or airborne spread

During the procedure we get close to a potentially combative patient (hypoxia), remove their protective surgical mask, and perform some of the following aerosolising procedures:

Potential aerosolising procedures:

Positive pressure ventilation with inadequate seal

Cardiopulmonary resuscitation (prior to intubation)

Tracheal suction (without a closed system)

Laryngoscopy

Tracheal intubation

Front-of-neck airway procedures (including tracheostomy, cricothyroidotomy)

Our plan for rapid-sequence induction has been modified to provide protection against these risks in line with the guidelines produced by the Safe Airway Society

The important changes to our airway checklist are:

Negative pressure room for intubation (ideally ICU preferred)

Dedicated COVID-19 airway team

Increased PPE with supervised donning and doffing

Modified airway circuit (viral filter and in-line suction included)

Remove bougie through gauze or use stylet

ETT clamping (when not attached to closed circuit)

No apnoeic oxygenation

No bagging during procedure

Intubation using a sequenced action card (read by the team leader)

During the pandemic, departments should regularly reassess whether all patients are intubated with a COVID-19 specific model or only those with symptoms suspicious for COVID-19 infection

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au

Reference

Brewster D, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 2020;212(10):472-481. doi:10.5694/mja2.50598

Airway Checklist (COVID-19)

COVID checklist

COVID checklist 2

© Agency for Clinical Innovation 2021