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Notfall + Rettungsmedizin

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25.03.2021 | Originalien

Effect of using barrier devices on intubation times and performance—a randomized, prospective, crossover manikin study

verfasst von: Asim Enes Ozbek, M.D., Emre Sanci, M.D., Huseyin Cahit Halhalli, M.D., Asst. Prof.

Erschienen in: Notfall + Rettungsmedizin | Sonderheft 1/2021

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Abstract

Background

The impact of barrier devices on endotracheal intubation times is unknown.

Objective

We sought to compare the effects using conventional personal protective equipment, an aerosol box, and a transparent plastic drape on intubation times by experienced emergency physicians on a manikin in both the sniffing and ramped positions in a randomized, prospective cross-over study design.

Methods

A total of 13 experienced emergency physicians performed endotracheal intubations on a manikin in both the sniffing and ramped positions using conventional personal protective equipment (PPE), an aerosol box, and a transparent plastic drape. The primary outcome was intubation time; secondary outcomes included first-pass success rates and ratings of difficulty in accessing the device, inserting the endotracheal tube into the glottis, maneuvering the laryngoscope, and clear vision of the manikin’s face.

Results

The use of an aerosol box or transparent plastic drape increased intubation times in both the sniffing and ramped positions. First-pass success rates did not differ between the groups. Perceptions of difficulty accessing the device, inserting the endotracheal tube into the glottis, maneuvering the laryngoscope, and obtaining a clear view of the manikin’s face to the model were higher when using the aerosol box and transparent plastic drape compared to intubation with only PPE.

Conclusion

An aerosol box and transparent plastic drape may increase intubation times during endotracheal intubation of coronavirus disease 2019 (COVID-19) patients in both the sniffing and ramped positions. Further research should investigate the utility of these devices during endotracheal intubation.

Trial registration number and date: NCT04412226; 31 May 2020.

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Ansari U, Mendonca C, Danha R et al (2020) The effects of personal protective equipment on airway management: an in-situ simulation. Trends Anaesth Crit Care 34:23–27. https://doi.org/10.1016/j.tacc.2020.07.003CrossRef

Begley JL, Lavery KE, Nickson CP, Brewster DJ (2020) The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study. Anaesthesia 75:1014–1021. https://doi.org/10.1111/anae.15115CrossRefPubMed

Brewster DJ, Chrimes N, Do TB et al (2020) Consensus statement: safe airway society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust 212:472–481. https://doi.org/10.5694/mja2.50598CrossRefPubMedPubMedCentral

Canelli R, Connor CW, Gonzalez M et al (2020) Barrier enclosure during endotracheal Intubation. N Engl J Med 382:1957–1958. https://doi.org/10.1056/NEJMc2007589CrossRefPubMed

Carlson JN, Zocchi M, Marsh K et al (2019) Procedural experience with intubation: results from a national emergency medicine group. Ann Emerg Med 74:786–794. https://doi.org/10.1016/j.annemergmed.2019.04.025CrossRefPubMed

CDC (2020) Coronavirus disease 2019 (COVID-19) in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Accessed 11 Aug 2020

Cook TM, El-Boghdadly K, McGuire B et al (2020) Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the difficult airway society, the association of Anaesthetists the intensive care society, the faculty of intensive care medicine and the royal college of anaesthetists. Anaesthesia 75:785–799. https://doi.org/10.1111/anae.15054CrossRefPubMedPubMedCentral

Driver BE, Prekker ME, Klein LR et al (2018) Effect of use of a Bougie vs endotracheal tube and stylet on first-attempt Intubation success among patients with difficult airways undergoing emergency Intubation: a randomized clinical trial. JAMA 319:2179. https://doi.org/10.1001/jama.2018.6496CrossRefPubMedPubMedCentral

Emami N, Tanner T, Ogundipe F et al (2020) Drape to prevent disease transmission during endotracheal intubation. Am J Infect Control. https://doi.org/10.1016/j.ajic.2020.06.212CrossRefPubMedPubMedCentral

10.

Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-coV‑2 admitted to ICus of the Lombardy region, Italy. JAMA 323:1574–1581. https://doi.org/10.1001/jama.2020.5394CrossRefPubMedPubMedCentral

11.

Ing EB, Xu QA, Salimi A, Torun N (2020) Physician deaths from corona virus (COVID-19) disease. Occup Med 70:370–374. https://doi.org/10.1093/occmed/kqaa088CrossRef

12.

Khandelwal N, Khorsand S, Mitchell SH, Joffe AM (2016) Head-elevated patient positioning decreases complications of emergent tracheal intubation in the ward and intensive care unit. Anesth Analg 122:1101–1107. https://doi.org/10.1213/ANE.0000000000001184CrossRefPubMed

13.

Kovacs G, Law JA, McCrossin C et al (2007) A comparison of a fiberoptic stylet and a Bougie as adjuncts to direct laryngoscopy in a manikin-simulated difficult airway. Ann Emerg Med 50:676–685. https://doi.org/10.1016/j.annemergmed.2007.05.022CrossRefPubMed

14.

Lai HY (2020) Aerosol box. https://sites.google.com/view/aerosolbox/home. Accessed 4 Sept 2020

15.

Lynch JB, Davitkov P, Anderson DJ et al (2020) Infectious diseases society of America guidelines on infection prevention for health care personnel caring for patients with suspected or known COVID-19. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1063CrossRefPubMedPubMedCentral

16.

Maniar A, Jagannathan B (2020) The aerosol box. J Anaesthesiol Clin Pharmacol 36:S141–S143. https://doi.org/10.4103/joacp.JOACP_283_20CrossRefPubMedPubMedCentral

17.

Martin LD, Mhyre JM, Shanks AM et al (2011) 3,423 emergency tracheal Intubations at a university hospitalairway outcomes and complications. Anesthesiology 114:42–48. https://doi.org/10.1097/ALN.0b013e318201c415CrossRefPubMed

18.

Maruyama K, Tsukamoto S, Ohno S et al (2010) Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: a manikin study. Resuscitation 81:1014–1018. https://doi.org/10.1016/j.resuscitation.2010.03.041CrossRefPubMed

19.

Mascha EJ, Schober P, Schefold JC et al (2020) Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic. Anesth Analg 131:24–30. https://doi.org/10.1213/ANE.0000000000004849CrossRefPubMedPubMedCentral

20.

Matava CT, Yu J, Denning S (2020) Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth 67:902–904. https://doi.org/10.1007/s12630-020-01649-wCrossRefPubMed

21.

Nolan JP, Kelly FE (2011) Airway challenges in critical care. Anaesthesia 66:81–92. https://doi.org/10.1111/j.1365-2044.2011.06937.xCrossRefPubMed

22.

Okada Y, Nakayama Y, Hashimoto K et al (2020) Ramped versus sniffing position for tracheal intubation: a systematic review and meta-analysis. Am J Emerg Med. https://doi.org/10.1016/j.ajem.2020.03.058CrossRefPubMed

23.

Sanfilippo F, Tigano S, Palumbo GJ et al (2020) Systematic review of simulated airway management whilst wearing personal protective equipment. Br J Anaesth 125:e301–e305. https://doi.org/10.1016/j.bja.2020.06.011CrossRefPubMed

24.

Semler MW, Janz DR, Russell DW et al (2017) A multicenter, randomized trial of ramped position vs sniffing position during endotracheal Intubation of critically ill adults. Chest 152:712–722. https://doi.org/10.1016/j.chest.2017.03.061CrossRefPubMedPubMedCentral

25.

Sorbello M, El-Boghdadly K, Schumacher J, Ahmad I (2020) Personal protective equipment, airway management, and systematic reviews. Comment on Br J Anaesth 2020; 125: e301–5. Br J Anaesth 125:e360–e361. https://doi.org/10.1016/j.bja.2020.06.038CrossRefPubMed

26.

Sorbello M, Rosenblatt W, Hofmeyr R et al (2020) Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. Br J Anaesth 125:880. https://doi.org/10.1016/j.bja.2020.08.038CrossRefPubMed

27.

Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (2020) The epidemiological characteristics of an outbreak of 2019 novel Coronavirus diseases (COVID-19)—China, 2020. Zhonghua Liu Xing Bing Xue Za Zhi 2:113–122. https://doi.org/10.46234/ccdcw2020.032CrossRef

28.

Tran K, Cimon K, Severn M et al (2012) Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. https://doi.org/10.1371/journal.pone.0035797CrossRefPubMedPubMedCentral

29.

Turner JS, Ellender TJ, Okonkwo ER et al (2017) Feasibility of upright patient positioning and intubation success rates at two academic EDs. Am J Emerg Med 35:986–992. https://doi.org/10.1016/j.ajem.2017.02.011CrossRefPubMed

30.

Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China. JAMA 323:1061. https://doi.org/10.1001/jama.2020.1585CrossRefPubMedPubMedCentral

31.

Wang W, Xu Y, Gao R et al (2020) Detection of SARS-coV‑2 in different types of clinical specimens. JAMA 323:1843–1844. https://doi.org/10.1001/jama.2020.3786CrossRefPubMedPubMedCentral

32.

Weingart SD, Levitan RM (2012) Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 59:165–175.e1. https://doi.org/10.1016/j.annemergmed.2011.10.002CrossRefPubMed

33.

Wu Z, McGoogan JM (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 323:1239–1242. https://doi.org/10.1001/jama.2020.2648CrossRef

Titel: Effect of using barrier devices on intubation times and performance—a randomized, prospective, crossover manikin study
verfasst von: Asim Enes Ozbek, M.D.
Emre Sanci, M.D.
Huseyin Cahit Halhalli, M.D., Asst. Prof.
Publikationsdatum: 25.03.2021
Verlag: Springer Medizin
Erschienen in: Notfall + Rettungsmedizin / Ausgabe Sonderheft 1/2021
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-021-00860-6

Springerpflege

Abstract

Background

Objective

Methods

Results

Conclusion

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