Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study [published online ahead of print, 2022 Mar 23].

This multicentre observational study was designed to bridge the gap in knowledge about potential adverse respiratory events during airway management in children with COVID-19 with a lot of earlier data reliant on adult studies.

Data was collected from 78 centres internationally in 2 phases over a 2-week period each.  In       phase 1, outcome data was collected for all general anaesthesia cases in children for that period and in phase 2, outcomes were assessed for proven or suspected (symptomatic but untested or awaiting testing) COVID-19 positive children. In total, 7896 children were analysed of which 329 were proven or suspected COVID-19 positive.

The primary aim was to compare incidence of hypoxaemia between COVID positive and negative patients and the secondary aim was to study the incidence of complications with airway management in this cohort. The type of devices used for airway management, and also differences in the incidence of complications in the symptomatic versus asymptomatic COVID positive patient was noted amongst other parameters.

Children with COVID-19 were more likely to have an intravenous rapid sequence induction and have their airway secured with tracheal intubation (P<0.001) compared to the COVID negative cohort. COVID positive children were also less likely to be ventilated via face mask (P<0.001). The use of video-laryngoscopy and seniority of the anaesthetist attempting to secure the airway also achieved significance (P<0.001) when comparing with the COVID negative group.

The incidence of hypoxaemia in the COVID positive group was 7% compared to 3% in the COVID negative group and the peak of this occurrence was at airway device removal. The overall risk of all airway management related complications was 12% in the COVID positive group as compared to 6% in the COVID negative group. Symptomatic children were more likely (25% versus 6%) than asymptomatic children to have adverse airway events. The use of barriers such as plastic drapes during airway management was associated with greater risk of airway complications, primarily at extubation in COVID positive patients.

Take home message:

 The study looked at over 8000 cases but less than 5% of them were COVID positive, limiting the ability to detect differences in the outcomes. Nevertheless, this study provides useful insight and highlights the morbidity and adverse airway events in a COVID positive child undergoing a general anaesthetic. Children who are proven or suspected COVID positive have a 2.7 times greater risk of hypoxaemia during a general anaesthetic with increased risk of both severe hypoxaemia and laryngospasm. The use of barriers, especially during emergence, increases the risk of mild hypoxaemia in these children. This reinforces the thought that general anaesthesia in COVID positive children does carry a significant risk. Studies reviewing longer term outcomes beyond the immediate postoperative period in larger numbers of COVID positive children are still required to validate these findings.

Reviewed by Dr Priya Sreedharan