Measurement of the Aerosol Generating Potential of Intubation, Extubation and associated airway procedures – MAGPIE study

Research Question What are the relative risks of aerosol production from airway management techniques used during surgery or intensive care, and what strategies can be employed to reduce aerosol generation? Background The COVID-19 pandemic has had an unprecedented impact on global health and the world economy.

The SARS-CoV-2 virus is highly contagious and the potential of airborne viral transmission from aerosols is a concern.

Certain medical interventions, including those for anaesthesia and intensive care, are designated 'aerosol generating procedures' (AGPs) and deemed to carry increased risk of viral transmission. There is currently little to no quantitative evidence on the aerosolisation risk for many AGPs. Current national and international AGP guidelines are based on weak epidemiological evidence.

Stringent measures introduced to minimise the potential risk of aerosolised SARS-CoV-2 transmission to staff and patients have reduced the ability of the NHS to restart important services including elective and cancer surgery.

These methods have prolonged operations and reduced healthcare efficiency to 60% of capacity. £15bn has been allocated for PPE acquisition which is more than 10% of the annual NHS budget.

Surgical waiting lists are expected to double by the end of 2020 from 4million to 10million patients The use of enhanced PPE: Is hugely costly for the NHS Impairs communication between teams Increases the risk of medical errors Reduces staff and patient interactions Increases stress and anxiety for healthcare workers and patients Produces vast quantities of non-recyclable waste This study aims to quantify the aerosol generated by currently identified AGPs.

Methods WS1 - MAGPIE study Working with the Bristol Aerosol Research Centre, I will use highly sensitive, accurate optical particle sizers to analyse the airborne particles generated by common AGPs used in anaesthesia and intensive care.

This will quantitate aerosol concentration, size distribution and persistence of particles generated during these AGPs WS2 - AGPercept survey A national survey of medical professionals involved in performing AGPs will determine attitudes towards the risk of viral transmission and impacts of precautions against bioaerosols.

This will be undertaken both before and after dissemination of the WS1 results to identify barriers to practice change.

WS3 - ROADMAP study This aims to identify and develop strategies to reduce aerosol production during airway management procedures to allow essential NHS services to get back on track Benefits to patients and the NHS within 24 months This research aims to quantify aerosols generated from current AGPs.

If any investigated AGPs generate less aerosol than a standard cough, their relative risk of aerosolisation is low and may be declassified as an AGP.

This would enable more appropriate risk assessment and mitigation, potentially yield huge-cost savings for the NHS and improve theatre efficiency enabling resumption of surgical services.

Strategies will be explored to reduce the risk from AGPs identified as generating substantial aerosols to effectively prevent viral transmission. Dissemination will be undertaken to inform national AGP policies.

Future Benefits Understanding the potential for aerosol generation will be useful in assessing the risk of transmission of other respiratory pathogens, including novel emergent viruses.