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

Anaesthesia. 2020 Nov;75(11):1437-1447. doi: 10.1111/anae.15170. Epub 2020 Jul 9.

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.

Keywords: COVID-19; airway; coronavirus; healthcare workers; intubation.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / transmission*
  • Female
  • Health Personnel*
  • Humans
  • Intubation, Intratracheal*
  • Male
  • Middle Aged
  • Occupational Exposure / adverse effects*
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / transmission*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk
  • SARS-CoV-2