Early in the emergence of the COVID-19 crisis, LDI Senior Fellow and Penn Medicine Anesthesiologist Mark Neuman, MD, was one of many in his field to recognize the risk clinicians faced while inserting breathing tubes into coronavirus patients — and he began investigating how to improve the procedure’s safety.

Today, just weeks later, Neuman is the U.S. National Coordinator of the IntubateCOVID.org registry. That’s a crowdsourced data collection system in which clinicians record the daily details of their patient intubations as well as their own health outcomes. The goal is to improve the safety of clinicians by analyzing the data to identify best practices for those who must work so close to the breathing zones of highly infectious patients.

Breathing tube placements

One of the most insidious effects of a severe coronavirus infection is damage throughout the lungs that impedes the organs’ ability to process enough oxygen to sustain life; standard practice is to put such patients on a ventilator, or an external mechanical breathing system. But the first step in hooking up a ventilator is the complicated and risky one of placing a tube down the patient’s windpipe. The way in which clinicians do that, along with other factors, like the protective gear they wear, relates in subtle ways to the clinicians’ own risk of being infected. 

The initial version of the IntubateCOVID registry was launched by National Health Service physicians at Guy’s & St. Thomas’ Hospital in London. Neuman learned of the UK program and quickly recognized its potential importance in the rising COVID-19 surge. 

A health services and clinical outcomes researcher, Neuman is Co-Director of the Penn Center for Perioperative Outcomes Research and Transformation (CPORT). After talks with the St. Thomas Hospital group, he led a team of Penn Medicine clinicians in organizing a U.S. arm of IntubateCOVID.org. 

Rapid nationwide adoption

Just weeks after its creation, IntubateCOVID.org now has participating chapters of reporting clinicians in twelve countries. In the U.S., 387 clinicians at 152 hospitals have thus far logged 982 intubations. Penn is the lead site in this national network.

“Our ability to launch this rapidly in the U.S. was due in huge part to the support we got from the University of Pennsylvania,” said Neuman. “This project is of high interest in the Department of Anesthesiology and we’ve had great engagement with the Emergency Department. A number of Penn offices worked with us to ensure we were doing all the things we needed to do from the perspective of human subjects, grants and contracts, HIPAA and privacy. All along the way, Penn people stood up and really wanted to help.”

“The process of using the registry is simple,” said Neuman. “Clinicians voluntarily enter their own case data and then return to the website at two weeks to tell us if they have new symptoms, or have gone to the hospital or if they’ve been diagnosed with COVID-19. It’s all focused on clinician outcomes and clinician safety, and encourages people to contribute data to figure out and improve their own practices.”

Higher risk techniques

“We collect information on what types of specific techniques were used, since we believe there could be certain techniques that increase risk to providers,” Neuman explained. “We collect the absolute minimum amount of information on patients, primarily only whether or not they were suspected or confirmed COVID cases.”

“It’s only been several weeks of data,” he continued, “but we’re already starting to see what kinds of personal protective equipment are being used by front line health care personnel and how there can be variations between using N95 masks or powered air purifying hoods.”

“We’ve already started to talk internally about how to communicate our lessons learned,” Neuman continued. “That would involve presenting data and also involve some of the stories we have to share. I’ve already learned a lot about human subjects regulation for network projects and I’m working with LDI Senior Fellow Holly Fernandez Lynch on some policy recommendations to make projects like ours more feasible in the long run. The idea is to make make our infrastructure and our regulatory structure more nimble and able to provide the sort of oversight that’s appropriate for research happening during a public health emergency, like this one.”