79 - Impact of COVID-19 Pandemic on Pediatric Emergency Endotracheal Intubation Practices and Outcomes

Poster Number: 79
Publication Number: 79.106

Kelsey A. Miller, Boston Children's Hospital, Brookline, MA, United States; Andzelika Dechnik, Boston Children's Hospital, Brookline, MA, United States; Andrew F. Miller, 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; Antonia S. Stang, University of Calgary, Calgary, AB, Canada; 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: Many institutions utilize protocols to optimize airway management in the pediatric emergency department (PED). Changes in protocols during the COVID-19 pandemic designed to minimize risk of staff exposure as well as differences in PED volume and patient mix may have impacted patient and clinician characteristics related to endotracheal intubation, as well as clinical outcomes.

Objective: To describe how intubation practices in PEDs has changed during the COVID-19 pandemic and determine the impact of these changes on procedural outcomes including rates of first attempt success (FAS) and tracheal intubation adverse events.

Design/Methods: This was a retrospective multicenter study of PEDs that participate in either the National Emergency Airway Registry or a national pediatric emergency medicine airway education collaborative. We included quality assurance data on all PED intubations performed in the 3 years preceding the declaration of the COVID-19 pandemic on March 11, 2020 and for the subsequent 12 months. Intubation-related protocols created or modified in response to the pandemic from participating sites were reviewed. Patient and procedural characteristics and clinical outcomes were compared across the pre-pandemic and pandemic time periods using Chi square or Fisher’s exact tests for categorical variables and Wilcox Rank sum tests for continuous variables. Protocols were analyzed based on predefined categories including personnel, oxygenation, and approach.

Results: A total of 1425 intubations were performed across 12 participating sites: 1129 before and 296 during the pandemic. Protocols were most commonly adapted to limit in-room personnel and maximize proceduralist experience and use of videolaryngoscopy (Table 1). Patient and procedural characteristics and clinical outcomes are shown in Table 2. Patients intubated during the pandemic were older (52 vs 36 months, P = 0.01) and less likely intubated for a primary respiratory indication (45 vs 54%, P < 0.01). Videolaryngoscopy was used more frequently during the pandemic (81 vs 75%, P = 0.03). There was no change in FAS. There were higher rates of moderate hypoxia (SpO2 80-89%) during the pandemic but no difference in severe hypoxia (SpO2 < 80%).Conclusion(s): The COVID-19 pandemic resulted in changes to institutional protocols around intubation in the PED and the characteristics of patients requiring advanced airway management. These changes in practice did not have broad impact on clinically significant outcomes.
Table 1: Changes to Airway Management Protocols in Response to COVID-19 Pandemic
Table 2: Comparison of Patient and Procedural Characteristics and Clinical Outcomes