Emergency Medical Services: COVID-19 crisis.

The COVID-19 epidemic required rapid and frequent adaptations from the prehospital emergency medical services (EMS). The exposure of EMS providers is significant, particularly during procedures at risk of aerosolization such as advanced airways management or cardiopulmonary resuscitation. EMS personal need to be equipped with appropriate personal protective equipment and trained in its use. Interhospital transfers from COVID-19 patients are complex and involve mainly intubated patients. The possible shortage of resources may motivate the implementation of dedicated prehospital triage and orientation recommendations, which should be consistent with the hospital processes.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

2022 CAS Virtual Annual Meeting

The proceedings contain 63 papers. The topics discussed include: a retrospective study to optimize post-anesthetic recovery time after ambulatory lower limb orthopedic procedures at a tertiary care hospital in Canada;a virtual airway evaluation as good as the real thing?;airway management during in hospital cardiac arrest by a consultant led airway management team during the COVID-19 pandemic: a prospective and retrospective quality assurance project;prevention of cautery induced airway fire using saline filled endotracheal tube cuffs: a study in a trachea airway fire model;smart phone assisted retrograde illumination versus conventional laryngoscope illumination for orotracheal intubation: a prospective comparative trial;time to single lung isolation in massive pulmonary hemorrhage simulation using a novel bronchial blocker and traditional techniques;cannabinoid type 2 receptor activation ameliorates acute lung injury induced systemic inflammation;bleeding in patients with end-stage liver disease undergoing liver transplantation and fibrinogen level: a cohort study;endovascular Vena Cavae occlusion in right anterior mini-thoracoscopic approach for tricuspid valve in patients with previous cardiac surgery;and mesenchymal stem cell extracellular vesicles as a novel, regenerative nanotherapeutic for myocardial infarction: a preclinical systematic review.

Evaluation and treatment of Coronavirus disease 2019 with obesity.

The pandemic of coronavirus disease 2019 (COVID-19) has spread worldwide and the mortality is high in severe COVID-19 patients. Clinical studies suggested that obesity is an independent risk factor for severe and dead cases of COVID-19. For COVID-19 patients with obesity, early evaluation of obesity-related comorbidities and aggressive treatments, including diet control, airway management, anticoagulant thromboprophylaxis, and management of comorbidities, are encouraged to improve their prognosis.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Non-invasive ventilation in >= 70 year old COVID-19 patients in a level two unit: retrospective cohort analysis, comparison with COVIP substudy and defense of a multifaceted work of breathing control driven strategy

Introduction: The debate about optimal management of patients with COVID-19 ARDS remains, including medical treatment, ventilatory strategies, awake proning and others. COVIP is a multicentric observational study with over 3000 patients under NIV. A substudy by Polok and al. evaluated patients (PTS) >= 70 years old. At our intermediate care unit (IU) we used a strategy of high dose corticosteroid started when the work of breathing (WOB) increased, prolonged awake prone positioning (> 12 h) and high CPAP ventilatory strategy. We describe our cohort of >= 70 years old NIV PTS and compare it to COVIP substudy results. Method(s): Descriptive retrospective study. Data were collected from electronic medical records of 95 COVID-19 PTS aged 70 years old or above under NIV at the IU between September/20 and March/21. Categorical data are presented as frequency (percentage) and were compared using chi2-test. Continuous variables were compared using Mann-Whitney U test. Cohort results were compared with those from Polok et al. COVIP substudy (COVIPss). Result(s): 95 of PTS were submitted to NIV. Median age was 76 years and 49.5% were male, versus 75.7 and 71.4% in COVIPss. Median admission SOFA score was 4 and CFS was 3 with 14% considered frail (CFS > 5). In COVIPss median SOFA was 5 and 17% of PTS were frail. The preferred mode was CPAP with median maximum pressure of 13. Mean PaO2/fiO2 ratio after start of NIV was 125, 30% < 100. NIV failure occurred in 46.3% versus 74,7% in COVIPss. Our intra-unit mortality was 31.6%. 14 PTS (14.7%) were submitted to invasive mechanical ventilation and 57% of those died. In COVIPss mortality at 30d was 52.9% in NIV and 47.7 in IMV groups. Conclusion(s): We argue that NIV is a valid option for COVID ARDS management if supported by a multifaceted strategy such as ours, using prone and CPAP for WOB control. We agree with COVIPss authors as NIV trial should be short and intubation promptly if WOB not controlled. Comparison with COVIP substudy NIV failure and mortality results, support our belief.

Percutaneous tracheostomy in head and neck oncology surgery: How Covid-19 changed our practice

Enhanced experience in performing percutaneous tracheostomies during the COVID-19 pandemic resulted in changes to airway management protocol for patients undergoing major head and neck reconstructive surgery within our department. Most patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy. The aim of this study was to review our experience in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. All consecutive patients undergoing free flap reconstructive surgery for head and neck cancer between June 2020 and November 2021 were included, with 56 patients receiving a percutaneous tracheostomy. Data across a range of variables including age, BMI, comorbidities and complications was compared with 56 surgical tracheostomies performed for the same group of patients before the COVID-19 pandemic and resultant protocol changes. In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group;28.57% and 30.35% respectively. Analysis of the 16 patients who experienced complications in the percutaneous group led to development of selection criteria to identify appropriate patients to receive a percutaneous tracheostomy in future, based on factors such as BMI, bleeding risk and positioning deformities. The COVID-19 pandemic has offered a multitude of learning experiences for healthcare professionals to change our practice. In our unit, this has involved modifying the routine tracheostomy procedure used for airway management intra- and post-operatively in major head and neck reconstruction surgery.Copyright © 2023 The Authors

The use of ilioinguinal and iliohypogastric nerve block anesthesia in inguinal bladder hernia repair Minimally invasive anesthesia technique in inguinal bladder hernia repair

Aim: There are data showing that the use of minimally invasive anesthesia methods (local anesthesia, nerve blocks) as an alternative to traditional anesthesia methods used in inguinal hernia repair surgery is safe and effective. During the COVID-19 pandemic, which affected the whole world, we aimed to evaluate the use of minimally invasive anesthesia methods in patients with inguinal bladder hernia, as well as their perioperative and postoperative results in our pilot study. Material(s) and Method(s): We evaluated the perioperative and postoperative data of five patients with inguinal bladder hernia, who underwent surgery with local anesthesia and ilioinguinal/iliohypogastric nerve blockade, four of which were performed during the COVID-19 pandemic. Result(s): It is possible to perform inguinal bladder hernia surgery with local anesthesia and ilioinguinal/iliohypogastric nerve block, including in secondary cases. Better hemodynamic stabilization in the intraoperative period reduces the need for narcotic analgesics by providing effective analgesia in the postoperative period, as well as reducing the risk of contamination in airway control. Discussion(s): Performing inguinal bladder hernia surgery using local anesthesia and ilioinguinal/iliohypogastric nerve block provides reliable and effective analgesia during the perioperative and postoperative periods.Copyright © 2023, Derman Medical Publishing. All rights reserved.

A novel negative pressure isolation device reduces aerosol exposure: A randomized controlled trial

Background and aim: The COVID-19 pandemic has led to a proliferation of intubation barriers designed to protect healthcare workers from infection. We developed the Suction-Assisted Local Aerosol Containment Chamber (SLACC) and tested it in the operating room. The primary objectives were to determine the ease and safety of airway management with SLACC, and to measure its efficacy of aerosol containment to determine if it significantly reduces exposure to health care workers. Method(s): In this randomized clinical trial, adult patients scheduled to undergo elective surgery with general endotracheal anesthesia were screened and informed consent obtained from those willing to participate. Patients were randomized to airway management either with or without the SLACC device. Patients inhaled nebulized saline before and during anesthesia induction to simulate the size and concentration of particles seen with severe symptomatic SARS-CoV-2 infection. Result(s): 79 patients were enrolled and randomized. Particle number concentration (PNC) at the patients' and healthcare workers' locations were measured and compared between the SLACC vs. control groups during airway management. Ease and success of tracheal intubation were recorded for each patient. All intubations were successful and time to intubation was similar between the two groups. Healthcare workers were exposed to significantly lower particle number concentrations (#/cm3) during airway management when SLACC was utilized vs. control. The particle count outside SLACC was reduced by 97% compared to that inside the device. Conclusion(s): The SLACC device does not interfere with airway management and significantly reduces healthcare worker exposure to aerosolized particles during airway management.Copyright © 2023 Elsevier Ltd

Awake Intubation Techniques, and Why It Is Still an Important Skill to Master

Purpose of Review: Awake intubation has been a staple of difficult airway management since the first American Society of Anesthesiologists difficult airway guidelines were developed in the 1980s. In current anesthetic practice, use of second generation supraglottic airways and video laryngoscopy are ubiquitous. The goal of this review is to examine the impact that these airway advances have had on the use of awake intubation and the need to maintain this skill. Recent Findings: Despite advancements, evidence suggests that the rate of awake intubation has changed little over the last two decades. Recent literature has focused on the use of alternatives to the flexible intubation scope, including awake intubation with video laryngoscopy, combined video laryngoscopy-flexible intubation, and combined supraglottic airway-flexible intubation. Summary: Awake intubation remains an essential technique in airway management. Future research should focus on determining the specific patient populations that would benefit from the variety of awake intubation techniques now described.Copyright © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Airway Management and Otolaryngology Involvement in Pediatric Upper Respiratory Infections

Introduction: Viral upper respiratory tract infections (URTI) such as respiratory syncytial virus, rhinoenterovirus coronavirus, and others are common in children, and they can have serious effects on the pediatric airway. The literature is limited on how often ear, nose, and throat (ENT) clinician involvement is required in patients admitted with a URTI. This project aims to characterize and identify factors associated with ENT involvement in care of pediatric patients with positive respiratory virus panels (RVP) and if any require airway interventions. Method(s): A retrospective study was conducted collecting information on patient demographics, comorbidities, course of treatment, incidence of ENT consultation, and incidence of airway interventions (flexible laryngoscopy, intubation, tracheostomy, direct laryngoscopy, etc) for all pediatric patients with a positive RVP who were treated either inpatient or in the emergency department from January 2018 to January 2020 at a tertiary care academic facility. Result(s): A total of 1019 of 1317 consecutive charts with a positive RVP over a 2-year period were reviewed. Preliminary result analysis was completed for the 1019 completed charts. Twenty-eight patients (2.7%) required an ENT consultation. Congenital birth defects were significantly associated with ENT consultation (odds ratio [OR]=3.75;P=.001). Length of stay was significantly associated with higher rate of ENT consultation per day of stay (OR=1.07 per day of stay;P<.001). All other factors studied were not significantly associated with higher rate of ENT consult. Conclusion(s): The incidence of ENT consultation in inpatients with URTIs is relatively uncommon. The preliminary data of this study suggest congenital birth defects and longer length of stay could be used as potential markers to help identify patients who may be at increased risk for worse airway outcomes and need for further airway intervention.

Anesthetic Considerations for Chiari I Malformation in a BMI 62 Patient

Patients with Chiari I malformations present with tonsillar herniation below the foramen magnum causing abnormal spinal anatomy. Anesthesia challenges in this population include difficult airway management, monitoring intraoperative autonomic dysfunction, avoiding increased intracranial pressure, and accommodating sensitivity to neuromuscular blockade. We present a case with an additional airway management challenge due to morbid obesity with a BMI of 62. A 23 year old female with a history of Covid pneumonia and morbid obesity who presented with syringomyelia and Chiari I malformation. She initially presented with bilateral numbness, tingling, weakness, and pain in her hands. Imaging with MRI at the time showed downward displacement of the cerebellar tonsils with the tips reaching the lower portion of C1 and overall 10-12 mm displacement below the level of the foramen magnum. Syrinx was also visualized from the level of C1-C2 extending down to the level of T5-T6. Repeat MRI a year later showed no significant changes. However, she has worsening symptoms of pain in her right arm preventing her from working. She is agreeable to surgical decompression of the posterior fossa through a suboccipital craniotomy with resection of the posterior arch of C1 with duraplasty. Significant findings on the physical exam include Mallampati III, shorter thyromental distance, and limited range of motion of her cervical spine due to pain in her arms. We chose awake fiberoptic intubation due to difficult airway from morbid obesity and limited cervical spine range of motion and the consideration of hypercapnia induced from brief apnea the patient may not tolerate. She was premedicated with versed, glycopyrrolate, and dexmedetomidine, and given a 5% lidocaine paste lollipop to topicalize oropharynx. She was also started on a low dose remifentanil infusion for sedation during the awake fiberoptic approach. Blood pressure, heart rate, respiratory rate with continuous end-tidal capnography, and pulse oximetry were monitored during the awake fiberoptic intubation. A 7.0 endotracheal tube was lubricated with viscous lidocaine and placed over a fiberoptic scope. Once there was visualization of the vocal cords, additional 2% lidocaine was administered directly at the vocal cords. She was intubated smoothly on the first attempt. She was then immediately induced to general anesthesia with propofol and non-depolarizing muscle relaxant to avoid using succinylcholine due to the possible hypersensitivity caused by denervation. Intraoperatively, a conventional air warmer was used to prevent hypothermia. Invasive arterial blood pressure monitoring was applied. Normotensive blood pressure and normocapnia were maintained throughout the surgery. Muscular blockade was reversed with sugammadex at the end of surgery to ensure adequate ventilation especially with the patient's body habitus. Upon extubation, the patient had acute hypertension which was managed by nicardipine infusion and hydralazine boluses. Patient was taken to a neurosurgical intensive unit and monitored for two days. She was discharged home without any complication. In conclusion, anesthetic considerations for patients with Chiari I malformation include airway management, monitoring for autonomic dysfunction, avoiding increase in ICP, and optimizing postoperative neurological status with balanced anesthetic management.

RESUSCITATION AIRWAY MANAGEMENT AT A TERTIARY CARE CENTER THAT ENCOURAGES FIRST-CHOICE SUPRAGLOTTIC AIRWAY USE

SESSION TITLE: Hot Topics in Critical Care SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: Recent data from the national American Heart Association Get with the Guidelines Resuscitation registry suggests substantial hospital-to-hospital variation in airway management during in-hospital cardiac arrest (IHCA), with most patients undergoing endotracheal intubation. Less than 5% of IHCA patients receive a supraglottic airway (SGA). Over the past several years, SGAs have been studied extensively in out-of-hospital cardiac arrests (OHCA) with promising results and are widely used in the OHCA setting. In this study, we describe factors and airway characteristics at a center encouraging either SGA or endotracheal intubation (ETI) for IHCA advanced airway management. METHODS: We performed a retrospective observational study examining all cardiac arrests occurring at a multi-campus academic medical center between August 3, 2020 to July 11, 2021. Locations studied included general medical wards, telemetry units, and intensive care units (both medical and specialty ICUs, such as surgical or cardiac). Patients were excluded if they possessed an invasive airway at time of arrest, suffered an arrest in the ED or procedural areas (e.g., operating room, catheterization lab), or were SARS-CoV-2 positive. Of note, SGAs were not specifically discouraged during the COVID-19 pandemic at this institution. We compared patient, arrest, and airway characteristics between the SGA and endotracheal intubation (ETI) groups using t-tests or Fisher’s exact tests where appropriate. Given risk for confounding by indication, we did not compare patient outcomes between groups. RESULTS: A total of 97 patients were included in the study, of whom 82 (84.5%) received an advanced airway during cardiopulmonary resuscitation. Of these the initial airway was ETI in 46 (56.1%) arrests and SGA in 36 (43.9%) arrests. As compared to SGA, patients receiving ETI were younger (66.1 [±2.0] vs. 71.2 [±2.1], p=0.08), more likely to be obese (11.0% vs. 5.6%), and more likely to have pre-existing lung conditions (19.6% vs 11.1%)—although no difference reached the a priori defined α<0.5 level of significance. Other hypothesized differences were not as extreme including for body mass index (28.3 [±1.4] vs. 28.4 [±1.6]) and respiratory cause of arrest (34.8% vs. 47.2%). First pass success rate was 84.8% for ETI. Complications of airway management were rare with one patient in each group suffering vomiting, one instance of oropharyngeal bleeding in the SGA group, and one pneumothorax in the ETI group. CONCLUSIONS: At a center using both SGA and ETI during IHCA response, patients who were younger, more obese, and more commonly had underlying lung disease tended to receive ETI—although these associations were not statistically significant. Complications of both advanced airway modalities were rare. CLINICAL IMPLICATIONS: DISCLOSURES: No relevant relationships by jonathan daich No relevant relationships by Alex Li No relevant relationships by Ari Moskowitz No relevant relationships by Aron Soleiman

Taking Stock: Mobile Covid-19 airway trolleys, whose responsibility is it?

Introduction: During the COVID-19 pandemic, mobile airway trollies formed an integral part of the emergency airway management. The AAGBI and ICS produced consensus guidelines recommending a COVID-19 airway trolley or pack;however, the maintenance guidance of these trollies is unclear.1 The pandemic placed severe pressure on all critical care staff, especially nursing staff. The airway trolley checks were transitioned to the junior doctors after wave one at Chelsea and Westminster Hospital. Unfortunately, trollies were not adequately checked and stocked. This created potential delays with emergency tracheal intubations, jeopardizing patient safety. Using a Plan Do Study Act (PDSA) approach we attempted to understand the factors affecting our compliance and ultimately improve patient safety. Objectives: 1. Identify which group of ICU professionals should check the airway trollies 2. Identify the barriers to safety checks? 3. Assess which targeted interventions improve compliance with checks? Methods: Single centre, prospective data collection (surveys n= 23 and trollies checklist compliance) over a 7 month period. Data on the frequency and accuracy of the checks was collected monthly. Surveys were used to identify appropriate and targeted interventions. Interventions were made at each cycle to address shortfalls in checks. Results: 1. 87% of staff believed that doctors (SHOs or SpRs) should check the airway trollies. 2. Barriers identified were 1. Lack of time or too busy 68% 2. Lack of organisation (finding stock or understanding equipment) 41% 3. Difficulty in finding the checklists 27% 3. Compliance improved from 34% to 77%, through various interventions (see graph below) At baseline (November) trolley check compliance was 34%. Changes were made to improve accessibility of checklists and equipment, and daily reminders were added to the morning operational handover. However, this only improved the check frequency to 38%. A staff survey highlighted recommendations for improvement: daily allocation of checks to a specific doctor and airway education. The trolley check allocation was built into the doctors' rota and airway trolley education was added to the departmental induction. There was minimal initial change in the following month but further applied education in the form of consultant-led airway skills sessions to engage the doctors in the process saw rates drastically improved to 75% and 77% over the following two months. Unpredictable challenges which negatively influenced the results were identified. These included surge rotas, including redeployed non-ICU doctors in checks and increased trolley numbers with increased ICU capacity. Conclusions: This quality improvement project, performed during the height of a pandemic, demonstrates the importance of adaptation and persistence to identify interventions that take into account the evolving clinical environment and human factors. It highlighted the difficulty in building new habits within the daily routine of junior doctors and the necessity of senior lead teaching to build the doctors' confidence, understanding and engagement with safety processes. Following the rigorous cycles, it is expected that the routine for the trolley checks is sufficient to withstand the rotations of junior doctors and expansion of the department in potential future waves of the pandemic.

Difficult and failed intubation management in obstetrics

Failed intubation in obstetrics remains a topical issue, a rare but potentially devastating complication of obstetric general anaesthesia. The 2015 guidelines produced following several years of collaborative work between the Difficult Airway Society (DAS) and Obstetric Anaesthetists' Association (OAA) remain the definitive text. While deaths from failed intubation have declined significantly over 30 years, the incidence of failed intubation remains fairly constant at 1:300, with the latest studies showing a rate of 1:224. This reflects the significant decline in the use of general anaesthesia for caesarean section over the last three decades;however, it also highlights a decreased exposure for trainees to tracheal intubation in the obstetric population.

Drowning: A practical review of prehospital intervention

Despite a recent decrease in drowning deaths, the number of drownings in Australia remains too high. Being reminded of key considerations for a drowning emergency is helpful preparation for health professionals who may take control at the scene © 2021 Medicine Today Pty Ltd. All rights reserved.

Comparative Study to Evaluate the Effect of Intubation Box on Tracheal Intubation Difficulty with King Vision ® and Truview Video Laryngoscope in Manikin in a Tertiary Care Hospital

Background: The procedures related to airway can be associated with increased risk of aerosolization of SARS-CoV-2 virus posing a high risk to the personnels involved. Novel methods like the intubation box have been developed to increase the safety of healthcare workers during intubation. Methods: In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS) 4 times using a King Vision ® videolaryngoscope and TRUVIEW PCD TM videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first-pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors measured with a pressure sensing device. Results: Intubation time and the pressure exerted on the incisors (detected by a click sound) were considerably higher in both groups when an intubation box was used. (Table 1) When comparing the two laryngoscopes, intubation time with the King Vision ® video laryngoscope was lower than that of TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both groups, rate of first pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO Score was not affected by intubation box but higher score was observed with King Vision ® laryngoscope. (Table 1,2). Conclusion: This study indicates that use of an intubation box makes intubation difficult and increases the time. King Vision ® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope.

Does mouth opening in patients with dental infections improve after induction of anaesthesia? A prospective observational study

Dental infection can cause reduced mouth opening which may make tracheal intubation after induction of general anaesthesia difficult. Although it is widely quoted in the literature that reduced mouth opening secondary to dental infection might not improve post-induction of anaesthesia,1 the evidence base for this is limited. The 4th National Audit Project in Anaesthesia highlighted that airway complications often resulted from poor assessment, inadequate planning of management, and a reluctance to use advanced airway techniques.2 An improved understanding and awareness of the effect of dental infection on mouth opening could help highlight potential airway difficulty, improving planning of airway management and the use of appropriate techniques to do this. We conducted a prospective observational study at the Royal Hallamshire Hospital, Sheffield. After study approvals (REC ref: 18/LO/1134, IRAS ID: 264468) were obtained, 11 patients presenting with dental infection requiring surgical management under general anaesthetic were recruited between December 2018 and January 2020. Maximal mouth opening was measured immediately before and after the induction of general anaesthesia using a TheraBite® ROM scale.3 The presence of a number of parameters associated with the severity of dental infection was also recorded. The mean pre-induction maximal mouth opening of the study participants was 18 mm (standard deviation [SD], 5.16 mm) whereas the mean post-induction maximal mouth opening was 22.3 (5.56) mm. Although the maximal mouth opening of 3 (17%) patients improved by more than 10 mm after induction of anaesthesia, the other 8 (73%) patient’s maximal mouth opening improved by less than 2 mm. Unfortunately, there was a large under-recruitment to the study in part owing to difficulties resulting from the COVID-19 pandemic. The study was therefore underpowered to perform further statistical analysis of the influence of induction of anaesthesia on a patient’s maximal mouth opening or to examine the influence of the presence of parameters associated with the severity of dental infection on maximal mouth opening. To our knowledge, this is the first study to look at the change in maximal mouth opening after induction of anaesthesia as a primary endpoint in patients with dental infection. Even in the context of the small sample size, the finding that 73% of the patients in the study had a less than 2 mm improvement in maximal mouth opening after induction is clinically highly relevant. A lack of improvement in reduced mouth opening has significant implications on airway management. This study clearly shows there is a reasonable prospect of this scenario in patients with dental infection and supports the practice of assuming mouth opening will not improve after induction of anaesthesia when planning airway management in these patients. References 1. Morosan M, Parbhoo A, Curry N. Continuing Education in Anaesthesia Critical Care & Pain 2012;12: 257–62 2. Cook TM, Woodall N, Frerk C. On behalf of the Fourth National Audit Project. Br J Anaesth 2011;106: 617–31 3. TheraBite® Range of Motion Scale. Available from: accessed date as: 5th November 2021

Impact of Covid-19 on Emergency Airway Management

Background: The main and serious problem associated with COVID19 is pneumonia and the sequelae acute respiratory distress syndrome. For this, airway management and respiratory care is of prime importance especially as an emergency COVID-19 disease care protocol. There are various emergency airway modalities that are available for such patients. Objectives: The aim of this review was to determine the benefits and drawbacks of the various airway management methods that have surfaced as game changers in COVID19 respiratory distress. Methodology: A thorough search was conducted across several databases, using mesh keywords and the boolean algorithm,. After removing duplicates, relevant literature was chosen, and studies were chosen for a qualitative review based on the available research on the issue. Results: It was observed that in mild to severe situations, HFNC improves oxygen saturation, but it cannot be used as the primary dependent modality. If fully achieved, awake proning is linked to better oxygenation and lower mortality. Although invasive ventilation saves lives, weaning is difficult, and significant mortality is seen in the elderly and those with comorbidities. Conclusion: It is concluded that the type of respiratory distress, age, resources available in the setting, ability of the person in charge, and comorbidities be considered when choosing an emergency airway management therapy/modality. The efficacy of the modalities utilised in emergency airway care and acute respiratory distress due to COVID19 Pneumonia can be better explained by a complete and exclusive systematic review and meta-analysis.