Table 2

Summary of common pitfalls seen during COVID-19 intubation simulations

Active failuresCorrections made
Failure to ensure appropriate equipment has been brought into the room, therefore increasing interaction between ‘cold’ room and ‘hot’ roomGoing through action cards to ensure adequate equipment available but not excessive
Forgetting to bring MERIT intubation action cards into ‘hot’ roomEnsuring action cards available for reference in ‘hot’ room
Failure to achieve a good seal during pre-oxygenation, increasing risk of aerosol generation due to high-flow oxygenTwo-hand technique for pre-oxygenation
Failure to turn the flow of oxygen down following pre-oxygenation and back on following intubationSecond anaesthetist to turn flow of oxygen on and off to reduce cognitive load of intubator
Not clamping the endotracheal tube in between disconnections, increasing risk of aerosol generationAnaesthetic assistant to remind anaesthetist of use of clamp, verbal confirmation prior to circuit disconnection
Difficulty hearing other members of the teamEnsuring communication is loud and clear, use of active listening techniques
Failure to undergo adequate planning in ‘cold’ room, ensuring every member of anaesthetic team is aware of planParticipants to go through intubation action cards and ensure all participants adequately briefed prior to entry into ‘hot’ room
Latent hazards
Equipment list missing in-line suction as part of circuitChange to action cards, attachment of in-line suction device reduces disconnections required for tracheal suction
ICU tube ties unavailable in theatresICU tube ties made available to MERIT team so endotracheal tubes did not need retying by ICU nursing staff
Doffing area in ‘hot’ room not clearly demarcatedDepartments and teams asked to clearly demarcate doffing areas in ‘hot’ room to ensure teams were aware and did not risk contamination
  • ICU, intensive care unit; MERIT, Mobile Emergency Rapid Intubation Teams.