R Scott Taylor1, Matthew Pitzer2, Grayson Goldman3, Augusta Czysz4, Thomas Simunich5, John Ashurst6. 1. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: RTaylor@conemaugh.org. 2. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: MPitzer@conemaugh.org. 3. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: GGoldman@conemaugh.org. 4. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: ACzysz@conemaugh.org. 5. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Research, Johnstown, PA, United States. Electronic address: TSimunich@conemaugh.org. 6. Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: ashurst.john.32.research@gmail.com.
Abstract
BACKGROUND: With the advancement of chemical, biological and nuclear warfare and the reemergence of infectious diseases, the possibility of intubating in personal protective equipment has become increasingly more real to the emergency physician. Human cadaveric models have been found to simulate real world conditions better than mannequins. The aim of the study was to determine the first pass success rate and average time to successful intubation while wearing Personal Protective Equipment (PPE). Secondarily, subjects were asked to rank their choice of a primary and back up device, as well as the most common encountered barriers using PPE. METHODS:Emergency medicine residents and pre-hospital providers were enrolled in a double randomized sequence to either intubation with direct laryngoscopy (DL), video laryngoscopy (VL), or the Supraglottic Airway Laryngopharyngeal Tube (SALT) in a cadaveric model while wearing level C PPE or without PPE. RESULTS: First pass success rate was 96% without PPE and 58% while wearing PPE when all devices were considered (p≤0.001). Time to intubation while wearing PPE was 35.0s while no PPE was 22.2s (p=0.012). While wearing PPE both DL and VL were found to allow for a faster intubation as compared to the SALT (23.0s and 18.8s; p=0.002 and p=0.006 respectively). No statistical difference was noted in intubations without PPE. Participants indicated the most common barrier to successful intubation included visibility while wearing hoods (73.7%). Furthermore, 52.6% of participants indicated they would choose DL as the primary method to intubate with if wearing PPE while 47.4% would choose VL. CONCLUSION: There is a statistically significant difference in first pass success and time to successful intubation while wearing and not wearing PPE in human cadaveric models.
RCT Entities:
BACKGROUND: With the advancement of chemical, biological and nuclear warfare and the reemergence of infectious diseases, the possibility of intubating in personal protective equipment has become increasingly more real to the emergency physician. Human cadaveric models have been found to simulate real world conditions better than mannequins. The aim of the study was to determine the first pass success rate and average time to successful intubation while wearing Personal Protective Equipment (PPE). Secondarily, subjects were asked to rank their choice of a primary and back up device, as well as the most common encountered barriers using PPE. METHODS: Emergency medicine residents and pre-hospital providers were enrolled in a double randomized sequence to either intubation with direct laryngoscopy (DL), video laryngoscopy (VL), or the Supraglottic Airway Laryngopharyngeal Tube (SALT) in a cadaveric model while wearing level C PPE or without PPE. RESULTS: First pass success rate was 96% without PPE and 58% while wearing PPE when all devices were considered (p≤0.001). Time to intubation while wearing PPE was 35.0s while no PPE was 22.2s (p=0.012). While wearing PPE both DL and VL were found to allow for a faster intubation as compared to the SALT (23.0s and 18.8s; p=0.002 and p=0.006 respectively). No statistical difference was noted in intubations without PPE. Participants indicated the most common barrier to successful intubation included visibility while wearing hoods (73.7%). Furthermore, 52.6% of participants indicated they would choose DL as the primary method to intubate with if wearing PPE while 47.4% would choose VL. CONCLUSION: There is a statistically significant difference in first pass success and time to successful intubation while wearing and not wearing PPE in human cadaveric models.
Authors: Jos H Verbeek; Blair Rajamaki; Sharea Ijaz; Christina Tikka; Jani H Ruotsalainen; Michael B Edmond; Riitta Sauni; F Selcen Kilinc Balci Journal: Cochrane Database Syst Rev Date: 2019-07-01
Authors: M Granell Gil; N Sanchís López; C Aldecoa Álvarez de Santulano; J A de Andrés Ibáñez; P Monedero Rodríguez; J Álvarez Escudero; R Rubini Puig; C S Romero García Journal: Rev Esp Anestesiol Reanim Date: 2021-03-24
Authors: Manuel Granell; Nerea Sanchis; Carlos Delgado; Manuel Lozano; Marcio Pinho; Cecilia Sandoval; Carolina S Romero; Cesar Aldecoa; Juan P Cata; Jorge Neira; Jose De Andres; Alejandro Herreros-Pomares; Guillermo Navarro Journal: J Clin Med Date: 2022-08-12 Impact factor: 4.964
Authors: Jos H Verbeek; Blair Rajamaki; Sharea Ijaz; Riitta Sauni; Elaine Toomey; Bronagh Blackwood; Christina Tikka; Jani H Ruotsalainen; F Selcen Kilinc Balci Journal: Cochrane Database Syst Rev Date: 2020-04-15
Authors: Leszek Gadek; Lukasz Szarpak; Lars Konge; Marek Dabrowski; Dominika Telecka-Gadek; Maciej Maslanka; Wiktoria Laura Drela; Marta Jachowicz; Lukasz Iskrzycki; Szymon Bialka; Frank William Peacock; Jacek Smereka Journal: J Clin Med Date: 2021-12-08 Impact factor: 4.241