Under the leadership of anesthesiologist Mark Neuman, MD, Penn Medicine is participating in intubateCOVID, a global registry designed to protect health care providers who intubate patients with COVID-19 and quantify their personal risk of disease development.
Started in early 2020 by a clinical team in the United Kingdom, the intubateCOVID registry was created to track exposures and outcomes among providers who perform intubations in confirmed or suspected COVID-19 disease.
“In order to inform and best protect clinicians performing these procedures, it’s imperative we understand how participating in intubation procedures may be linked to an individual’s risk of developing COVID-19,” Dr. Neuman explained in a 2020 interview, adding that among the study's goals was to capture and analyze large-scale data to identify the elements contributing to risk, including the use of specific techniques or equipment.
Dr. Neuman is the Horatio C. Wood Associate Professor of Anesthesiology at the Perelman School of Medicine, and a practicing anesthesiologist. Dr Neuman is the national lead for the registry. The Center for Perioperative Outcomes Research and Transformation within the Perelman School of Medicine at the University of Pennsylvania serves as the national coordinating center for the intubateCOVID registry in the United States.
A Year of COVID-19 Intubation Data: What We Learned
After a year of tracking global patterns in airway management activity and personal protective equipment (PPE) use, the intubateCOVID Registry announced on Twitter in March 2021 that it was closing its database to new submissions.
During its active data collection, the intubateCOVID registry published a series of articles that contributed valuable information to inform COVID-19 care and health policies in the United States and beyond.
Here's a recent example of what we learned:
IntubateCOVID 2021Update on the Success of First-Attempt Intubations
Reported in April 2021, the authors of intubateCOVID performed an observational cohort study based upon data gathered prospectively from the study for the period between March and October 2020. The broad objective of this investigation was to assess the relationship between intubation and operator characteristics in relation to to first-attempt intubation success. In all, the examination involved 4,476 intubations among 1,722 clinicians at 607 institutions across 32 countries.
Analysis of large scale data and specific techniques for intubation was among the original goals of IntubateCOVID, according to Dr. Neuman, who coordinated the study at Penn Medicine. Other foundational goals of the study included tracking intubations and consequent health outcomes of providers.Specific objectives for the recent secondary analysis of IntubateCOVID were to estimate the rate of success and complications during tracheal intubation attempts; describe the international practices of airway management in patients with suspected or confirmed COVID-19; and determine whether global variations in practices and outcomes exist between high-income countries and low- and middle-income countries.
Results: Multivariable analysis demonstrated that successful first attempts were more likely with rapid sequence intubations, when operators used powered air-purifying respirators, and with increasing operator experience. Although successful first-attempt intubation was noted in 89.7% of intubations, 0.5% required four or more attempts, an emergency surgical airway was required in 0.2%, and a composite variable of failed intubation occurred in 0.8%. Intubations performed in low- and middle-income countries were nearly half as likely to be successful on first attempt than in high-income countries.
While conceding the potential disadvantages of the study’s observational nature and lack of patient-level characteristics, the authors conclude that these results provide potentially useful information for global and local policy-making related to this and future pandemics.
For more information on the IntubateCOVID update, see the original article at the journal Anesthesiology.