{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:55:01Z","timestamp":1772168101319,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In response to COVID\u201019, we introduced and examined the effect of a raft of modifications to standard practice on adverse events and first\u2010attempt success (FAS) associated with ED intubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An analysis of prospectively collected registry data of all ED intubations over a 3\u2010year period at an Australian Major Trauma Centre. During the first 6 months of the COVID\u201019 pandemic in Australia, we introduced modifications to standard practice to reduce the risk to staff including: aerosolisation reduction, comprehensive personal protective equipment for all intubations, regular low fidelity simulation with \u2018sign\u2010off\u2019 for all medical and nursing staff, senior clinician laryngoscopist and the introduction of pre\u2010drawn medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 783 patients, 136 in the COVID\u201019 era and 647 in the pre\u2010COVID\u201019 comparator group. The rate of hypoxia was higher during the COVID\u201019 era compared to pre\u2010COVID\u201019 (18.4% <jats:italic>vs<\/jats:italic> 9.6%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.005). This occurred despite the FAS rate remaining very high (95.6% <jats:italic>vs<\/jats:italic> 93.8%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.42) and intubation being undertaken by more senior laryngoscopists (consultant 55.9% during COVID\u201019 <jats:italic>vs<\/jats:italic> 22.6% pre\u2010COVID\u201019, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). Other adverse events were similar before and during COVID\u201019 (hypotension 12.5% <jats:italic>vs<\/jats:italic> 7.9%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.082; bradycardia 1.5% <jats:italic>vs<\/jats:italic> 0.5%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.21). Video laryngoscopy was more likely to be used during COVID\u201019 (95.6% <jats:italic>vs<\/jats:italic> 82.5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and induction of anaesthesia more often used ketamine (66.9% <jats:italic>vs<\/jats:italic> 42.3%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and rocuronium (86.8% <jats:italic>vs<\/jats:italic> 52.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This raft of modifications to ED intubation was associated with significant increase in hypoxia despite a very high FAS rate and more senior first laryngoscopist.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.13809","type":"journal-article","created":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T02:50:55Z","timestamp":1622688655000},"page":"728-733","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Unintended consequences: The impact of airway management modifications introduced in response to <scp>COVID<\/scp>\u201019 on intubations in a tertiary centre emergency department"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2336-1525","authenticated-orcid":false,"given":"Christopher J","family":"Groombridge","sequence":"first","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Emergency and Trauma Centre, The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Surgery Central Clinical School, Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Maini","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Emergency and Trauma Centre, The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8799-077X","authenticated-orcid":false,"given":"Alexander","family":"Olaussen","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Emergency and Trauma Centre, The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Paramedicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yesul","family":"Kim","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Department of Surgery Central Clinical School, Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0183-7761","authenticated-orcid":false,"given":"Mark","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Department of Surgery Central Clinical School, Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"De Villiers","family":"Smit","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Victoria Australia"},{"name":"Emergency and Trauma Centre, The Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer059"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12496"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2019-208935"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12055"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15170"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50598"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50598"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12815"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12931"},{"key":"e_1_2_8_11_1","article-title":"Apnoeic oxygenation was associated with decreased desaturation rates during rapid sequence intubation in multiple Australian and New Zealand emergency departments","author":"Perera A","year":"2020","journal-title":"Emerg. 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