357 - Impact of COVID-19 Pandemic on Educational Opportunities for Endotracheal Intubation in the Pediatric Emergency Department

Poster Number: 357
Publication Number: 357.313

Kelsey A. Miller, Boston Children's Hospital, Brookline, MA, United States; Andrew F. Miller, Boston Children's Hospital, Brookline, MA, United States; Andzelika Dechnik, Boston Children's Hospital, Brookline, MA, United States; Gabrielle D'Ambrosi, Boston Children's Hospital, Allston, MA, United States; Michael C. Monuteaux, Boston Children's Hospital, Boston, MA, United States; Phillip M. Thomas, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Benjamin T. Kerrey, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Tara Neubrand, Children's Hospital Colorado/University of Colorado, Denver, CO, United States; Michael P. Goldman, Yale School of Medicine, New Haven, CT, United States; Ryan Breuer, John R. Oishei Children's Hospital, Buffalo, NY, United States; Aaron Donoghue, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Julien Ginsberg-Peltz, Baystate Medical Center, Amherst, MA, United States; Akira Nishisaki, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Joshua Nagler, Boston Children's Hospital Division of Emergency Medicine, Brookline, MA, United States

Background: Achieving and maintaining procedural competency in advanced airway management can be challenging in pediatric emergency medicine (PEM). During the COVID-19 pandemic, institutional practice changes implemented to maximize proceduralist safety and procedural efficiency as well as changes in patient volume and acuity may have further limited clinical opportunities for these clinicians to perform intubation.

Objective: To describe how opportunities to perform intubation in pediatric emergency departments (PEDs) changed for both trainees and attending physicians in response to the COVID-19 pandemic and the impact on procedural outcomes.

Design/Methods: This was a retrospective multicenter study of intubations performed at 12 PEDs participating in either the National Emergency Airway Registry or a national PEM airway education collaborative. Data were collected on PED intubations for the 3 years preceding the WHO-designated start of COVID-19 pandemic on March 11, 2020 and the following 12 months. Overall proportion and rate of opportunities per month for first and second intubation attempt opportunities were compared between the pre-pandemic and pandemic periods for each specialty, stratified by training level. Using multivariable logistic regression, first attempt success (FAS) was compared between the pre- and pandemic periods and by training level. We also tested for differences in the proportion of overall and severe tracheal intubation adverse events (TIAE; severe = aspiration, cardiac arrest, hypotension, desaturation < 80%).

Results: During the study period, 1425 intubations were performed: 1129 before the pandemic and 296 during the first year of the pandemic. The training level and specialty of the proceduralist performing the first and second attempts are shown in Tables 1 and 2. Pediatric residents and PEM fellows received proportionally fewer first and second attempts during the pandemic, resulting in a significant decrease in monthly opportunities. Opportunities for emergency medicine residents and faculty did not decrease. The rate of FAS did not change by time period or by clinician type after adjusting for co-variates (Table 3). Similarly, the proportion of TIAE (30% pre vs 33% pandemic, p = 0.3) and of severe TIAEs (17% vs 18%, p = 0.6) did not change.Conclusion(s): The COVID-19 pandemic resulted in decreased proportion and incidence of intubation opportunities for both pediatric residents and PEM fellows, without a change in clinical outcomes. We should consider how to increase intubation experience for current trainees and the necessity of limiting trainee attempts in the future.
Table 1: Changes in Proportion and Incidence of Intubation First Attempts
Table 2: Changes in Proportion and Incidence of Intubation Second Attempts