The effect of using personal protective equipment and aerosol box in the emergency department on the intubation times

Background: Endotracheal intubation is a procedure commonly performed in the emergency department (ED). Endotracheal intubation poses a risk of exposure to infectious aerosol droplets. Aim: The present study aims to test the effect of using an aerosol box (AB) and personal protective equipment (PPE) on the intubation time while performing endotracheal intubation manikin. Subjects and Methods: The study participants (11 emergency specialists, 11 emergency physicians, and 11 general practitioners) performed endotracheal intubation on a training manikin in three different airway simulations. Simulation 1 had neither PPE nor AB, simulation 2 had PPE, and simulation 3 had both PPE and AB. The intubation times, the number of intubation attempts, and the discomfort caused by the AB were recorded. Results: There was no significant difference in the number of intubation attempts between the physicians according to their position and airway simulations (p > 0.05). There was a significant difference at all time points except for the time to endotracheal tube cuff inflation in three different airway simulations using PPE and an AB (p < 0.05). The median intubation times were longer using PPE and an AB. Conclusion: The use of PPE and an AB significantly increases the total intubation time.

[1]  E. Durant,et al.  Comparison of the Characteristics of Intubation Airway Barrier Devices Using a Simulated Airway Task Trainer , 2022, Cureus.

[2]  M. Cannesson,et al.  Implementing COVID-19 Simulation Training for Anesthesiology Residents , 2022, MedEdPORTAL : the journal of teaching and learning resources.

[3]  C. Johnstone,et al.  Developing a simulation programme to train airway management during the COVID-19 pandemic in a tertiary-level hospital , 2021, BMJ Simulation & Technology Enhanced Learning.

[4]  Emre Şancı,et al.  Effect of using barrier devices on intubation times and performance—a randomized, prospective, crossover manikin study , 2021, Notfall + Rettungsmedizin.

[5]  K. Chew,et al.  COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study , 2020, Emergency Medicine Journal.

[6]  E. Violato,et al.  Impact of aerosol box on intubation during COVID-19: a simulation study of normal and difficult airways , 2020, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[7]  A. Shrestha,et al.  COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation , 2020, Open access emergency medicine : OAEM.

[8]  E. Sarmiento,et al.  Effect of an Aerosol Box on Intubation in Simulated Emergency Department Airways: A Randomized Crossover Study , 2020, The western journal of emergency medicine.

[9]  R. Carter,et al.  Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID‐19 pandemic , 2020, Anaesthesia.

[10]  S. Marshall,et al.  Thinking outside the (acrylic) box: a framework for the local use of custom‐made medical devices , 2020, Anaesthesia.

[11]  D. Brewster,et al.  The aerosol box for intubation in coronavirus disease 2019 patients: an in‐situ simulation crossover study , 2020, Anaesthesia.

[12]  P. Ward,et al.  Maximising application of the aerosol box in protecting healthcare workers during the COVID‐19 pandemic , 2020, Anaesthesia.

[13]  J. Veall,et al.  The use of UV fluorescent powder for COVID‐19 airway management simulation training , 2020, Anaesthesia.

[14]  J. Tseng,et al.  Protecting against COVID-19 aerosol infection during intubation , 2020, Journal of the Chinese Medical Association : JCMA.

[15]  T. Cook,et al.  Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic – a narrative review , 2020, Anaesthesia.

[16]  Robert Canelli,et al.  Barrier Enclosure during Endotracheal Intubation , 2020, The New England journal of medicine.

[17]  R. Lu,et al.  Detection of SARS-CoV-2 in Different Types of Clinical Specimens. , 2020, JAMA.

[18]  D. Cook,et al.  Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis , 2014, Critical care medicine.

[19]  E. Bergamasco,et al.  Training in healthcare during and after COVID-19: proposal for simulation training. , 2021, Revista da Associacao Medica Brasileira.