Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

TY - JOUR

T1 - Risks to healthcare workers following tracheal intubation of patients with COVID-19

T2 - a prospective international multicentre cohort study

AU - El-Boghdadly, K

AU - Wong, D J N

AU - Owen, R

AU - Neuman, M D

AU - Pocock, S

AU - Carlisle, J B

AU - Johnstone, C

AU - Andruszkiewicz, P

AU - Baker, P A

AU - Biccard, B M

AU - Bryson, G L

AU - Chan, M T V

AU - Cheng, M H

AU - Chin, K J

AU - Coburn, M

AU - Jonsson Fagerlund, M

AU - Myatra, S N

AU - Myles, P S

AU - O'Sullivan, E

AU - Pasin, L

AU - Shamim, F

AU - van Klei, W A

AU - Ahmad, I

N1 - © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

PY - 2020/11

Y1 - 2020/11

N2 - Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.

AB - Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.

KW - COVID-19

KW - airway

KW - coronavirus

KW - healthcare workers

KW - intubation

UR - http://www.scopus.com/inward/record.url?scp=85087149032&partnerID=8YFLogxK

U2 - 10.1111/anae.15170

DO - 10.1111/anae.15170

M3 - Article

C2 - 32516833

SN - 1365-2044

VL - 75

SP - 1437

EP - 1447

JO - Anaesthesia

JF - Anaesthesia

IS - 11

ER -