Intubation strategy in COVID-19 era: An observational study

Aerosol protection equipment aim at protecting the anaesthesiologist, from aerosol-borne infections, namely, severe acute respiratory syndrome corona virus-2.

We improvised the first-generation intubation box (IB) by increasing its dimensions, including heat and moisture exchanger with filter, suction catheter, and attaching arm sleeves to make a modified intubation box (MIB). The impact of IB, MIB and transparent sheets (TS) on the patient outcomes during airway management was evaluated.

A significant difference in median (interquartile range in minutes) was observed in time to intubate between IB (4 [4-5]); TS (0.5 [0.3-0.5]) and MIB (0.3 [0.3-1.5]): P = 0.004); and airway devices; McCoy (0.5 [0.3-2]), CMac (0.5 [0.3-1.5]): P = 0.004. First-pass success was 100% with the TS, whereas more than three attempts were required with IB 66.7% and 5.2% with MIB. Video laryngoscope was associated with less airway-related adverse events (ARAEs). The need for mask ventilation (and hence possible aerosolisation) was maximum with IB. All the ARAEs resolved uneventfully. No breach of personal protective equipment was observed; none of the health-care professionals involved in patient care developed any symptoms suggestive of COVID-19.

Video laryngoscope is favourable for managing airway in COVID-19 times. In view of the ongoing pandemic and added protection that it offers, it is worthwhile to include the MIB in the armamentarium for managing the airway of patients with COVID-19.