Consensus guidelines for managing the airway in patients
with COVID-19: Guidelines from the Difficult Airway Society,
the Association of Anaesthetists the Intensive Care Society,
the Faculty of Intensive Care Medicine and the Royal College
of Anaesthetists
Anaesthesia 2020; 75: 785-99.
Citations: 325
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A
Summary
Severe acute respiratory syndrome-corona virus-2, which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway
management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of
patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together
at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately
available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers,
the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The
fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or
unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support
clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with
local workplace policies.
Armstrong RA, Kane AD, Cook TM, 2020
Outcomes from intensive care in patients with COVID-19: a systematic review and
meta-analysis of observational studies
Anaesthesia 2020; 75: 1340-9.
Altmetric score: 1527
Summary
The emergence of coronavirus disease 2019 (COVID-19) has led to high demand for intensive care services worldwide. However,
the mortality of patients admitted to the intensive care unit (ICU) with COVID-19 is unclear. Here, we perform a systematic review
and meta-analysis, in line with PRISMA guidelines, to assess the reported ICU mortality for patients with confirmed COVID-19. We
searched MEDLINE, EMBASE, PubMed and Cochrane databases up to 31 May 2020 for studies reporting ICU mortality for adult
patients admitted with COVID-19. The primary outcome measure was death in intensive care as a proportion of completed ICU
admissions, either through discharge from the ICU or death. The definition thus did not include patients still alive on ICU. Twenty-four
observational studies including 10,150 patients were identified from centres across Asia, Europe and North America. In-ICU
mortality in reported studies ranged from 0 to 84.6%. Seven studies reported outcome data for all patients. In the remaining studies,
the proportion of patients discharged from ICU at the point of reporting varied from 24.5 to 97.2%. In patients with completed ICU
admissions with COVID-19 infection, combined ICU mortality (95%CI) was 41.6% (34.0–49.7%), I2 = 93.2%). Sub-group analysis by
continent showed that mortality is broadly consistent across the globe. As the pandemic has progressed, the reported mortality
rates have fallen from above 50% to close to 40%. The in-ICU mortality from COVID-19 is higher than usually seen in ICU admissions
with other viral pneumonias. Importantly, the mortality from completed episodes of ICU differs considerably from the crude
mortality rates in some early reports.
The scientific and medical community responded heroically to the COVID-19 pandemic. Information was shared freely around the
world, paywalls were demolished, and journals including
Anaesthesia worked tirelessly to expedite publication.
I have selected papers based on two metrics: the conventional one is citations and the more modern is Altmetrics, which takes
account of social media interest. Whether one of these supplants the other, who can tell, but by any standards these are fantastically
important papers. The turnaround time for the guidelines paper is astonishing – accepted 17 March, first published online 27 March, and appearing in the June print issue.
Mike Kinsella
Editor, Anaesthesia News