Management of the Difficult Airway in the COVID-19 Pandemic: Illustrative Complex Head and Neck Cancer Scenario

Overview

Journal Head Neck

Specialties General Surgery
Oncology

Date 2020 Apr 17

PMID 32298017

Citations 7

Authors

Christopher H Rassekh

Carolyn M Jenks

E Andrew Ochroch

Jennifer E Douglas

Bert W OMalley Jr

Gregory S Weinstein

Affiliations

Soon will be listed here.

Abstract

Background: This case highlights challenges in the assessment and management of the "difficult airway" patient in the SARS-CoV-2 (COVID-19) pandemic era.

Methods: A 60-year-old male with history of recent transoral robotic surgery resection, free flap reconstruction, and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea 1 month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion.

Results: The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided.

Conclusions: This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other "difficult airway" patients during the COVID-19 epidemic.

Citing Articles

Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review.

Meister K, Pandian V, Hillel A, Walsh B, Brodsky M, Balakrishnan K Otolaryngol Head Neck Surg. 2020; 164(5):984-1000.

PMID: 32960148 PMC: 8198753. DOI: 10.1177/0194599820961990.

Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines.

Weinstein G, Cohen R, Lin A, OMalley Jr B, Lukens J, Swisher-McClure S Head Neck. 2020; 42(7):1507-1515.

PMID: 32584447 PMC: 7362039. DOI: 10.1002/hed.26318.

Impact of the first month of Covid-19 lockdown on oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments.

Laccourreye O, Mirghani H, Evrard D, Bonnefont P, Brugel L, Tankere F Eur Ann Otorhinolaryngol Head Neck Dis. 2020; 137(4):273-276.

PMID: 32565242 PMC: 7293504. DOI: 10.1016/j.anorl.2020.06.007.

Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study.

Civantos A, Byrnes Y, Chang C, Prasad A, Chorath K, Poonia S Head Neck. 2020; 42(7):1597-1609.

PMID: 32496637 PMC: 7300862. DOI: 10.1002/hed.26292.

Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic.

Maniakas A, Jozaghi Y, Zafereo M, Sturgis E, Su S, Gillenwater A Head Neck. 2020; 42(6):1194-1201.

PMID: 32342541 PMC: 7267348. DOI: 10.1002/hed.26206.

References

Zuo M, Huang Y, Ma W, Xue Z, Zhang J, Gong Y . Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. Chin Med Sci J. 2020; . PMC: 7367670. DOI: 10.24920/003724. View

Rassekh C, Zhao J, Martin N, Chalian A, Atkins J . Tracheostomy Complications as a Trigger for an Airway Rapid Response: Analysis and Quality Improvement Considerations. Otolaryngol Head Neck Surg. 2015; 153(6):921-6. DOI: 10.1177/0194599815612759. View

Wang X, Pan Z, Cheng Z . Association between 2019-nCoV transmission and N95 respirator use. J Hosp Infect. 2020; 105(1):104-105. PMC: 7134426. DOI: 10.1016/j.jhin.2020.02.021. View

Li Y, Xia L . Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. AJR Am J Roentgenol. 2020; 214(6):1280-1286. DOI: 10.2214/AJR.20.22954. View

Cormack R, Lehane J . Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39(11):1105-11. View

Rassekh C, Jenks C, Ochroch E, Douglas J, OMalley Jr B, Weinstein G . Management of the difficult airway in the COVID-19 pandemic: Illustrative complex head and neck cancer scenario. Head Neck. 2020; 42(6):1273-1277. PMC: 7262249. DOI: 10.1002/hed.26175. View

Hatten K, Brody R, Weinstein G, Newman J, Bur A, Chalian A . Defining the Role of Free Flaps for Transoral Robotic Surgery. Ann Plast Surg. 2017; 80(1):45-49. DOI: 10.1097/SAP.0000000000001263. View

Chan J, Wong E, Lam W . Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. 2020; 146(6):519-520. DOI: 10.1001/jamaoto.2020.0488. View

Givi B, Schiff B, Chinn S, Clayburgh D, Iyer N, Jalisi S . Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg. 2020; 146(6):579-584. DOI: 10.1001/jamaoto.2020.0780. View

10.

Vukkadala N, Rosenthal E, Patel Z . In Response to COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review. Laryngoscope. 2020; 130(10):E526. PMC: 7300673. DOI: 10.1002/lary.28770. View

11.

Tran K, Cimon K, Severn M, Pessoa-Silva C, Conly J . Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7(4):e35797. PMC: 3338532. DOI: 10.1371/journal.pone.0035797. View

12.

Balakrishnan K, Schechtman S, Hogikyan N, Teoh A, McGrath B, Brenner M . COVID-19 Pandemic: What Every Otolaryngologist-Head and Neck Surgeon Needs to Know for Safe Airway Management. Otolaryngol Head Neck Surg. 2020; 162(6):804-808. DOI: 10.1177/0194599820919751. View

13.

Li Y, Peng A, Yang X, Xiao Z, Wu W, Wang Q . Clinical manifestation and management of primary malignant tumors of the cervical trachea. Eur Arch Otorhinolaryngol. 2013; 271(2):225-35. DOI: 10.1007/s00405-013-2429-9. View

14.

Hillel A, Pandian V, Mark L, Clark J, Miller C, Haut E . A novel role for otolaryngologists in the multidisciplinary Difficult Airway Response Team. Laryngoscope. 2014; 125(3):640-4. DOI: 10.1002/lary.24949. View

15.

Atkins J, Rassekh C, Chalian A, Zhao J . An Airway Rapid Response System: Implementation and Utilization in a Large Academic Trauma Center. Jt Comm J Qual Patient Saf. 2017; 43(12):653-660. DOI: 10.1016/j.jcjq.2017.07.002. View

16.

Richa F, Chalhoub V, Gebrayel W, El-Hage C, El Jamal P, Yazbeck P . Upper lip bite test versus Modified Mallampati classification in predicting difficult laryngoscopy and/or intubation among morbidly obese patients. J Clin Anesth. 2020; 63:109761. DOI: 10.1016/j.jclinane.2020.109761. View

17.

Chen W, Ling W, Lu C, Hao Y, Lin Z, Ling L . Which preventive measures might protect health care workers from SARS?. BMC Public Health. 2009; 9:81. PMC: 2666722. DOI: 10.1186/1471-2458-9-81. View