Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

K. El-Boghdadly, D. J.N. Wong, R. Owen, M. D. Neuman, S. Pocock, J. B. Carlisle, C. Johnstone, P. Andruszkiewicz, P. A. Baker, B. M. Biccard, G. L. Bryson, M. T. V. Chan, M. H. Cheng, K. J. Chin, M. Coburn, M. J. Fagerlund, S. N. Myatra, P. S. Myles, L. Pasin, F. ShamimW. A. van Klei, I. Ahmad

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206 Citations (Scopus)


Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use, and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors, and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18–48 [0–116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1%, and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in females, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.

Original languageEnglish
Pages (from-to)1437-1447
Number of pages11
Issue number11
Publication statusPublished - Nov 2020


  • airway
  • coronavirus
  • COVID-19
  • healthcare workers
  • intubation

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