Feasibility of pre-hospital emergency anaesthesia in the cabin of an AW169 helicopter wearing personal protective equipment during COVID-19

Hunter, K.; McHenry, AS.; Curtis, L.; Ter Avest, E.; Mitchinson, S.; Griggs, JE.; Lyon, RM.

Objective Pre-hospital emergency anaesthesia in the form of rapid sequence intubation (RSI) is a critical intervention delivered by advanced pre-hospital critical care teams. Our previous simulation study determined the feasibility of in-aircraft RSI. We now examine whether this feasibility is preserved in a simulated setting, when clinicians wear personal protective equipment (PPE) for aerosol-generating procedures (AGP) for in-aircraft, on-the-ground RSI. Methods Air Ambulance Kent Surrey Sussex is a Helicopter Emergency Medical Service (HEMS) which utilises an AW169 cabin simulator. Wearing full AGP PPE (eye protection, FFP3 mask, gown, gloves), 10 doctor-paramedic teams performed RSI in a standard “can intubate, can ventilate” scenario and a “can't intubate, can't oxygenate” (CICO) scenario. Pre-specified timings were reported, and participant feedback was sought by questionnaire. Results RSI was most commonly performed by direct laryngoscopy and was successfully achieved in all scenarios. Time to completed endotracheal intubation (ETI) was fastest (287s) in the standard scenario and slower (370s, p=.01) in the CICO scenario. Time to ETI was not significantly delayed by wearing PPE in the standard (p=.19) or CICO variant (p=.97). Communication challenges, equipment complications and PPE difficulties were reported, but ways to mitigate these also reported. Conclusion In-aircraft RSI (aircraft on-the-ground) whilst wearing PPE for AGPs had no significant impact on time to successful completion of ETI in a simulated setting. Patient safety is paramount in civilian HEMS, but the adoption of in-aircraft RSI could confer significant patient benefit in terms of pre-hospital time saving and further research is warranted.