The SAM has developed a statement for difficult airway management of the adult patient with COVID-19. Unlike standard difficult airway guidelines, COVID-19 adds an additional dimension of provider exposure risk during intubation and extubation. Because difficult airway management may take longer than standard airway management, strict adherence to PPE protocols will reduce exposure risk to providers during difficult airway management. Optimal preoxygenation and minimizing BMV can also reduce aerosolization risk. The risks and benefits of various strategies to deliver supplemental oxygen throughout the process of difficult airway management should be considered. When a patient's airway risk assessment suggests that ATI is an appropriate choice of technique, procedures that may cause increased aerosolization of secretions should be avoided. For optimal intubating conditions, the patient should be anesthetized with full muscle relaxation before intubation. Videolaryngoscopy is recommended as a first-line strategy for airway management, assuming availability and expertise. If emergent invasive airway access is indicated, then we recommend the use of a simple surgical technique, such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This report represents the collaborative recommendations of the management of an adult with COVID-19 and difficulties in intubation and extubation to minimize provider risk, maximize first-pass success, and maintain patient safety (Figures 1,3,4).
AEC = airway exchange catheter; AGP = aerosol-generating procedures; AGREE = Appraisal of Guidelines Research and Evaluation; ARDS = acute respiratory distress syndrome; ATI = awake tracheal intubation; BIPAP = bilevel positive airway pressure; BMV = bag-mask ventilation; CICO = cannot intubate, cannot oxygenate; COVID-19 = coronavirus disease 2019; CPAP = continuous positive airway pressure; CVCI = cannot ventilate, cannot intubate; EtO 2 = end-tidal O2; ETT = endotracheal tube; FDA = US Food and Drug Administration; FIO 2 = fraction of inspired oxygen; FIS = flexible intubation scope; HCW = health care worker; HEPA = high-efficiency particulate absorbing filter; HFNO = high-flow nasal oxygen; NIPPO = noninvasive positive pressure oxygenation; NIPPV = non-invasive positive pressure ventilation; IPAP = inhalation positive airway pressure; IV = intravenous; PAPR = powered air-purifying respirator; POM = procedural oxygen mask; PPE = personal protective equipment; RSI = rapid sequence induction; SAM = Society for Airway Management; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; SGA = supraglottic airway; VL = videolaryngoscopy
Anesth Analg. 2021;133(4):876-890. © 2021 International Anesthesia Research Society