Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study |
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| Authors: | K. El-Boghdadly D. J. N. Wong R. Owen M. D. Neuman S. Pocock J. B. Carlisle C. Johnstone P. Andruszkiewicz P. A. Baker B. M. Biccard G. L. Bryson M. T. V. Chan M. H. Cheng K. J. Chin M. Coburn M. Jonsson Fagerlund S. N. Myatra P. S. Myles E. O’Sullivan L. Pasin F. Shamim W. A. van Klei I. Ahmad |
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| Affiliation: | 1. Department of Anaesthesia and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;2. Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK;3. Penn Centre for Peri-operative Outcomes Research and Transformation, University of Pennsylvania, USA;4. Department of Anaesthesia, Peri-operative Medicine and Intensive Care, Torbay Hospital, UK;5. Department of Anaesthesiology and Intensive Care, Institute of Tuberculosis and Lung Diseases, Poland;6. University of Auckland, New Zealand;7. Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa;8. Department of Anaesthesia and Pain Medicine, University of Ottawa, Canada;9. The Chinese University of Hong Kong, Hong Kong;10. Division of Anaesthesiology, Singapore General Hospital, Singapore;11. Department of Anaesthesia and Pain Medicine, University of Toronto, Canada;12. Department of Anaesthesia, University Hospital RWTH, Aachen, Germany;13. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Sweden;14. Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, India;15. Department of Anaesthesiology and Perioperative Medicine, Monash University, Australia;16. St James’ Hospital, Ireland;17. Department of Anaesthesia and Intensive Care, Azienda Ospedale-Università di Padova, Italy;18. Department of Anaesthesiology, Aga Khan University Hospital, Pakistan;19. Division Anaesthesia, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Netherlands;20. Department of Anaesthesia and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK King’s College London, UK |
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| Abstract: | 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. |
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| Keywords: | airway COVID-19 coronavirus healthcare workers intubation |
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