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

K El-Boghdadly ORCID logo; DJN Wong; R Owen; MD Neuman; S Pocock; JB Carlisle; C Johnstone; P Andruszkiewicz; PA Baker; BM Biccard; +13 more... GL Bryson; MTV Chan; MH Cheng; KJ Chin; M Coburn; M Jonsson Fagerlund; SN Myatra; PS Myles; E O'Sullivan; L Pasin; F Shamim; WA van Klei; I Ahmad; (2020) Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia, 75 (11). pp. 1437-1447. ISSN 0003-2409 DOI: 10.1111/anae.15170
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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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