The effects of personal protective equipment on airway management: An in-situ simulation

https://doi.org/10.1016/j.tacc.2020.07.003Get rights and content

Highlights

  • A high standard of successful airway management is possible in personal protective equipment.

  • All successful intubations were carried out by the first intubator with 93% first attempt success rate.

  • Mean intubation time was 47.9s using a McGrath® video laryngoscope.

  • Palpation of cricothyroid membrane and video laryngoscopy were poorly performed steps.

  • Additional training of newly introduced devices is of paramount importance.

Abstract

The novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organisation on 11th March and has led to over 41,000 deaths in the UK. Public Health England guidance for aerosol generating procedures (AGP) requires the donning of personal protective equipment (PPE). We evaluated airway management skills using an in-situ emergency simulation. The scenarios were video recorded and scored by two independent assessors using a skill specific checklist. A total of 34 airway management procedures were evaluated. The checklist involved 13 steps with a maximum score of 26. The median (IQR [range]) checklist score was 25 (24-25 [20-26]). Four teams failed to intubate the trachea and proceeded to manage the airway using a supraglottic airway device. The mean (SD) intubation time was 47.9 (16.5) seconds and two anaesthetists (7%) required a second attempt. Our results show that airway management can be carried out successfully whilst donned in PPE. However, additional training in using newly introduced devices such as a McGrath® video laryngoscope is of paramount importance.

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