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Kluj P, Fedorczak A, Fedorczak M, Gaszyński T, Kułak C, Wasilewski M, Znyk M, Bartczak M, Ratajczyk P. Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial. Healthcare (Basel) 2023; 11:884. [PMID: 36981541 PMCID: PMC10048466 DOI: 10.3390/healthcare11060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). METHODS The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-viewTM VL, UESCOPE® VL, ProVu® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. RESULTS The longest IT was noted when the UESCOPE® (29.4 s) and ProVu® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu®, UESCOPE® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE® and ProVu®. CONCLUSIONS The intubation times performed by paramedics in PPE-AGP using UESCOPE® and ProVu® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.
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Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Anna Fedorczak
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Cezary Kułak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Mikołaj Wasilewski
- Clinic of Anesthesiology and Intensive Therapy, Medical University of Lodz, 92-213 Lodz, Poland
| | - Mateusz Znyk
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Maria Bartczak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
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Mormando G, Paganini M, Alexopoulos C, Savino S, Bortoli N, Pomiato D, Graziano A, Navalesi P, Fabris F. Life-Saving Procedures Performed While Wearing CBRNe Personal Protective Equipment: A Mannequin Randomized Trial. Simul Healthc 2021; 16:e200-e205. [PMID: 33428358 DOI: 10.1097/sih.0000000000000540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Moreover, subjects involved in biological events are considered infectious even after decontamination and need to be managed while wearing personal protective equipment (PPE), as seen with Ebola and COVID-19 pandemic. With this simulation mannequin trial, we assessed the impact of CBRNe PPE on cardiopulmonary resuscitation and combat casualty care procedures. METHODS We compared procedures performed by emergency medicine and anesthesiology senior residents, randomized in 2 groups (CBRNe PPE vs. no PPE). Chest compression (CC) depth was defined as the primary outcome. Time to completion was calculated for the following: tourniquet application; tension pneumothorax needle decompression; peripheral venous access (PVA) and intraosseous access positioning; and drug preparation and administration. A questionnaire was delivered to evaluate participants' perception. RESULTS Thirty-six residents participated. No significant difference between the groups in CC depth (mean difference = 0.26 cm [95% confidence interval = -0.26 to 0.77 cm, P = 0.318]), as well as for CC rate, CC complete release, and time for drugs preparation and administration was detected. The PPE contributed to significantly higher times for tourniquet application, tension pneumothorax decompression, peripheral venous access, and intraosseous access positioning. The residents found simulation relevant to the residencies' core curriculum. CONCLUSIONS This study suggests that cardiopulmonary resuscitation can be performed while wearing PPE without impacting quality, whereas other tasks requiring higher dexterity can be significantly impaired by PPE.Trial Registration Number: NCT04367454, April 29, 2020 (retrospectively registered).
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Affiliation(s)
- Giulia Mormando
- From the Department of Medicine (DIMED) (G.M., M.P., C.A., S.S., F.F.), University of Padova, Padova; Venice Emergency Medical Service Operations Center (N.B., D.P.), Venezia; and Istituto di Anestesia e Rianimazione-Azienda Ospedaliera Universitaria di Padova (A.G., P.N.), Padova, Italy
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Schumacher J, Carvalho C, Greig P, Ragbourne S, Ahmad I. Influence of respiratory protective equipment on simulated advanced airway skills by specialist tracheal intubation teams during the COVID-19 pandemic. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 39:21-27. [PMID: 38620908 PMCID: PMC8123411 DOI: 10.1016/j.tacc.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Background The COVID-19 pandemic has highlighted the importance of respiratory protective equipment for clinicians performing airway management. Aim To evaluate the impact of powered air-purifying respirators, full-face air-purifying respirators and filtering facepieces on specially trained anaesthesiologists performing difficult airway procedures. Methods All our COVID-19 intubation team members carried out various difficult intubation drills: unprotected, wearing a full-face respirator, a filtering facepiece or a powered respirator. Airway management times and wearer comfort were evaluated and analysed. Results Total mean (SD) intubation times did not show significant differences between the control, the powered, the full-face respirator and the filtering facepiece groups: Airtraq 6.1 (4.4) vs. 5.4 (3.1) vs. 6.1 (5.6) vs. 7.7 (7.6) s; videolaryngoscopy 11.4 (9.0) vs. 7.7 (4.3) vs. 9.8 (8.4) vs. 12.7 (9.8) s; fibreoptic intubation 16.6 (7.8) vs.13.8 (6.7) vs. 13.6 (8.1) vs. 16.9 (9.2) s; and standard endotracheal intubation by direct laryngoscopy 8.1 (3.5) vs. 6.5 (5.6) vs. 6.2 (4.2) vs. 8.0 (4.4) s, respectively. Use of the Airtraq achieved the shortest intubation times. Anaesthesiologists rated temperature and vision significantly better in the powered respirator group. Conclusions Advanced airway management remains unaffected by the respiratory protective equipment used if performed by a specially trained, designated team. We conclude that when advanced airway skills are performed by a designated, specially trained team, airway management times remain unaffected by the respiratory protective equipment used.
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Affiliation(s)
- Jan Schumacher
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clarissa Carvalho
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Greig
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Ragbourne
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Ahmad
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Borges IBDS, Carvalho MRD, Quintana MDS, Lima DVMD, Barbosa BL, Oliveira ABD. Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies. Rev Bras Enferm 2021; 74:e20200313. [PMID: 34320149 DOI: 10.1590/0034-7167-2020-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. METHODS Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. RESULTS Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir's subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. CONCLUSION Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.
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Affiliation(s)
| | | | | | | | - Bruno Leal Barbosa
- Universidade Federal do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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Liti A, Giusti GD, Gili A, Giontella M, Dell'Omo S, Camerlingo V, Fronteddu A, Galazzi A, Bambi S. Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020016. [PMID: 33263351 PMCID: PMC8023114 DOI: 10.23750/abm.v91i12-s.10832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND During medical emergencies, one of the main steps to improve patient outcomes is to achieve airway management. Orotracheal intubation is highly effective for advanced airway management, but it requires experienced health professionals. The use of a supraglottic airway device (SAD) is an acceptable alternative. AIM To assess which of the four considered SADs takes the shortest time and the lowest number of attempts to be correctly placed. The secondary aim was to evaluate the influence of some characteristics of the study population on time taken and number of attempts required. METHODS A crossover trial was conducted at the Advanced Medical Simulation Center of the University of Perugia (Italy) between June and September 2017. Eighty-three nurses were enrolled in the study. Each participant was asked to place four different SADs in a manikin: Laryngeal Tube Suction-D (LTS-D), i-gel™, Ambu® Laryngeal Mask AuraGain™ and LMA® Protector™ Cuff Pilot™. RESULTS The median insertion time for the different devices was: 8.0 seconds (s) for LTS-D, 6.0 s for i-gel, 5.4 s for AuraGain, 5.8 s for LMA Protector (p<0.05); the median number of insertion attempts was: 2 for LTS-D, 1 for i-gel, AuraGain and LMA Protector (p<0.05). There was no significant relationship between insertion time and attempts required and the participants' working experience, training, or knowledge of the devices. CONCLUSION With the exception of LTS-D, which had the worst performance, there was a high degree of homogeneity between the studied SADs in terms of time and attempts required to achieve correct placement.
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Affiliation(s)
| | - Gian Domenico Giusti
- Azienda Ospedaliero Universitaria di Perugia. Didactic Tutor. School of Nursing Department of Experimental Medicine University of Perugia .
| | - Alessio Gili
- PhD, Department of Experimental Medicine University of Perugia.
| | - Mirella Giontella
- Azienda Ospedaliero Universitaria di Perugia. School of Nursing Department of Medicine University of Perugia .
| | | | | | | | - Alessandro Galazzi
- Department of Anesthesia, Intensive Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy .
| | - Stefano Bambi
- Medical and Surgical Intensive Care Unit. Azienda Ospedaliero Universitaria Careggi, Florence.
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Borges IBDS, Carvalho MRD, Quintana MDS, Oliveira ABD. Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies. Rev Lat Am Enfermagem 2020; 28:e3347. [PMID: 32876287 PMCID: PMC7458572 DOI: 10.1590/1518-8345.4024.3347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/30/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I2= 74%). The “2ndgeneration supraglottic devices” subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).
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Sanfilippo F, Tigano S, Palumbo GJ, Astuto M, Murabito P. Systematic review of simulated airway management whilst wearing personal protective equipment. Br J Anaesth 2020; 125:e301-e305. [PMID: 32624187 PMCID: PMC7293489 DOI: 10.1016/j.bja.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023] Open
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Schumacher J, Arlidge J, Dudley D, Sicinski M, Ahmad I. The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study. Anaesthesia 2020; 75:1301-1306. [PMID: 32335900 PMCID: PMC7267320 DOI: 10.1111/anae.15102] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 01/07/2023]
Abstract
The current international COVID‐19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air‐purifying respirators and powered air‐purifying respirators during simulated difficult airway scenarios. Twenty‐five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered respirator group; however, noise levels were perceived to be significantly lower than in the standard respirator group. We conclude that standard and powered respirators do not significantly prolong simulated advanced intubation procedures.
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Affiliation(s)
- J Schumacher
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Arlidge
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Dudley
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Sicinski
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ott T, Tschöpe K, Toenges G, Buggenhagen H, Engelhard K, Kriege M. Does the revised intubating laryngeal tube (ILTS-D2) perform better than the intubating laryngeal mask (Fastrach)? - a randomised simulation research study. BMC Anesthesiol 2020; 20:111. [PMID: 32393169 PMCID: PMC7212614 DOI: 10.1186/s12871-020-01029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The intubating laryngeal tube (ILTS-D™) and the intubating laryngeal mask (Fastrach™) are devices that facilitate both extraglottic application and blind tracheal intubation. A revised model of the iLTS-D (for scientific reasons called ILTS-D2) has been designed but not yet evaluated. Therefore, we compared the ILTS-D2 with the established Fastrach under controlled conditions in a prospective randomised controlled simulation research study. METHODS After ethical approval, we randomised 126 medical students into two groups. Each participant received either Fastrach or ILTS-D2 to perform five consecutive ventilation attempts in a manikin. The primary endpoint was the time to ventilation in the last attempt of using the devices as extraglottic devices. Secondary endpoints were the time to tracheal intubation and the success rates. RESULTS There was no relevant difference between the two devices in the time to ventilation in the last of five attempts (Fastrach: median 14 s [IQR: 12-15]; ILTS-D2: median 13 s [IQR: 12-15], p = 0.592). Secondary endpoints showed a 2 s faster blind tracheal intubation using the Fastrach than using the ILTS-D2 (Fastrach: median 14 s [IQR: 13-17]; ILTS-D2: median 16 s [IQR: 15-20] p < 0.001). For both devices, the success rates were 100% in the last attempt. CONCLUSIONS Concerning extraglottic airway management, we could not detect a relevant difference between the revised ILTS-D2 and the Fastrach under laboratory conditions. We advocate for an evaluation of the ILTS-D2 in randomised controlled clinical trials. TRIAL REGISTRATION Identifier at clinicaltrials.gov: NCT03542747. May 31, 2018.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Katharina Tschöpe
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology, and Informatics, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf-Frey Lernklinik Central Education Platform, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Beaven A, Sellon E, Ballard M, Parker P. Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state. BMJ Mil Health 2020; 167:75-79. [PMID: 32086262 DOI: 10.1136/jramc-2019-001261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy of tourniquets while wearing British military CBRN individual protective equipment (IPE). METHODS 12 volunteers from the counter CBRN instructors' course allowed testing on 24 legs. A Combat Application Tourniquet (C-A-T) was applied to all volunteers at the level of the midthigh. 12 legs were tested while wearing CBRN IPE (both operator and simulated casualty), and the control group of 12 legs was tested while wearing conventional combat dress state (both operator and simulated casualty). The order of leg laterality and dress state were sequenced according to a prerandomised system. Efficacy was measured via use of an ultrasound probe at the popliteal artery. Tourniquets were considered effective if arterial flow was completely occluded on ultrasound imaging. Data were collected on time to successful application, failure of tourniquets and pain scores as rated by the visual analogue scale (1-10). RESULTS There were no failures of tourniquet application in the CBRN group, and two failures (17%) in the control group. Failures were pain threshold exceeded (n=1) and tourniquet internal strap failure (n=1). The mean application time for the CBRN group was 28.5 s (SD 11.7) and 23.7 s (SD 9.8) for the conventional combat group. There was no statistically significant difference (p=0.27). The median CBRN pain score was 2.0 (IQR 2.0-3.5). The median control pain score was 4.0 (IQR 3-6). This was a statistically significant difference (p=0.002). CONCLUSION C-A-Ts applied to simulated casualties in CBRN IPE at the midthigh are at least as efficacious as those applied to the midthigh in a conventional combat dress state. The pain experienced was less in CBRN IPE than when in a conventional combat dress state.
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Affiliation(s)
- Alastair Beaven
- Clinical Department, 202 Field Hospital, Birmingham, UK .,Trauma and Orthopaedic Surgery, Royal Centre for Defence Medicine, Birmingham, UK
| | - E Sellon
- Radiology, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Ballard
- Radiology, Royal Centre for Defence Medicine, Birmingham, UK
| | - P Parker
- Trauma and Orthopaedic Surgery, Royal Centre for Defence Medicine, Birmingham, UK
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Impact of Clinician Personal Protective Equipment on Medical Device Use During Public Health Emergency: A Review. Disaster Med Public Health Prep 2019; 14:273-283. [DOI: 10.1017/dmp.2019.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ABSTRACTThe aim of this systematic review is to evaluate the impact of personal protective equipment (PPE) on medical device use during public health emergency responses. We conducted a systematic literature search of peer-reviewed journals in PubMed, Web of Science, and EBSCO databases. Twenty-nine of 92 articles published between 1984 and 2015 met the inclusion criteria for the review. Although many medical device use impacts were reported, they predominantly fell into 3 categories: airway management, drug administration, and diagnostics and monitoring. Chemical, biological, radiological, and nuclear (CBRN)-PPE increased completion times for emergency clinical procedures by as much as 130% and first attempt failure rates by 35% (anesthetist) versus 55% (non-anesthetist). Effects of CBRN-PPE use depend on device, CBRN-PPE level, and clinician experience and training. Continuous clinical training of responders in CBRN-PPE and device modifications can improve safety and effectiveness of medical device use during public health emergency response.
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Ott T, Barth A, Kriege M, Jahn-Eimermacher A, Piepho T, Noppens RR. The novel video-assisted intubating laryngeal mask Totaltrack compared to the intubating laryngeal mask Fastrach - a controlled randomized manikin study. Acta Anaesthesiol Scand 2017; 61:381-389. [PMID: 28251605 DOI: 10.1111/aas.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/13/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND The novel Totaltrack combines a supraglottic airway device with video laryngoscopic tracheal intubation. The intubation laryngeal mask Fastrach is an established device without visual control of intubation. We hypothesized that supraglottic ventilation success with Totaltrack would be similar to Fastrach, but intubation would be performed faster due to visual control of the procedure. METHODS Fifty-five anaesthesiologists were randomized into one of two study arms: Fastrach Totaltrack. After a standardized introduction, six consecutive attempts of supraglottic ventilation and intubation attempts with each of one of the devices were performed on an airway manikin. The combined primary outcome was: time to supraglottic ventilation and time to ventilation after intubation. Additionally, success rate and learning curves were evaluated. RESULTS Supraglottic time to ventilation was shorter when using the Fastrach compared to the Totaltrack (median: 7.8 s [confidence interval [CI]: 7.0-8.6 s] vs. 11 s [CI: 7.8-14.2 s], P < 0.001). Intubation was faster using the Fastrach compared to Totaltrack (median: 12.5 s, [CI: 10.1-14.9 s] vs. 23.3 s [CI: 21.5-25.1 s], P < 0.001). Success rate for supraglottic ventilation was comparable between Fastrach and Totaltrack (86-96%). Successful intubation via the device was 100% in Fastrach and ranged from 61% to 93% in Totaltrack, with a higher probability of successful intubation after four applications. CONCLUSION In this manikin-based study the novel Totaltrack did not prove superior to Fastrach despite a similar design. Video laryngoscopic control of supraglottic ventilation and endotracheal intubation was prolonged using the Totaltrack. Clinical trials are mandatory to evaluate the role of the Totaltrack in airway management.
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Affiliation(s)
- T. Ott
- Department of Anaesthesiology; Medical Centre of the Johannes Gutenberg University; Mainz Germany
| | - A. Barth
- Department of Anaesthesiology; Medical Centre of the Johannes Gutenberg University; Mainz Germany
| | - M. Kriege
- Department of Anaesthesiology; Medical Centre of the Johannes Gutenberg University; Mainz Germany
| | - A. Jahn-Eimermacher
- Institute of Medical Biostatistics, Epidemiology and Informatics; Medical Centre of the Johannes Gutenberg University; Mainz Germany
| | - T. Piepho
- Department of Anaesthesiology; Medical Centre of the Johannes Gutenberg University; Mainz Germany
| | - R. R. Noppens
- Department of Anaesthesiology; Medical Centre of the Johannes Gutenberg University; Mainz Germany
- Department of Anesthesia & Perioperative Medicine; Western University; London Ontario Canada
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Schumacher J, Arlidge J, Garnham F, Ahmad I. A randomised crossover simulation study comparing the impact of chemical, biological, radiological or nuclear substance personal protection equipment on the performance of advanced life support interventions. Anaesthesia 2017; 72:592-597. [DOI: 10.1111/anae.13842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J. Schumacher
- Department of Anaesthetics; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - J. Arlidge
- Department of Anaesthetics; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - F. Garnham
- Department of Emergency Medicine; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - I. Ahmad
- Department of Anaesthetics; Guy's and St Thomas' NHS Foundation Trust; London UK
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An J, Nam SB, Lee JS, Lee J, Yoo H, Lee HM, Kim MS. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e5801. [PMID: 28072732 PMCID: PMC5228692 DOI: 10.1097/md.0000000000005801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The i-gel has a gel-like cuff composed of thermoplastic elastomer that does not require cuff inflation. As the elimination of cuff inflation may shorten insertion time, the i-gel might be a useful tool in emergency situations requiring prompt airway care. This systematic review and meta-analysis of previous adult manikin studies for inexperienced personnel was performed to compare the i-gel with other supraglottic airways. METHODS We searched PubMed, the Cochrane Library, and EMBASE for eligible randomized controlled trials (RCTs) published before June 2015, including with a crossover design, using the following search terms: "i-gel," "igel," "simulation," "manikin," "manikins," "mannequin," and "mannequins." The primary outcomes of this review were device insertion time and the first-attempt success rate of insertion. RESULTS A total of 14 RCTs were included. At the initial assessment without difficult circumstances, the i-gel had a significantly shorter insertion time than the LMA Classic, LMA Fastrach, LMA Proseal, LMA Unique, laryngeal tube, Combitube, and EasyTube. However, a faster insertion time of the i-gel was not observed in comparisons with the LMA Supreme, aura-i, and air-Q. In addition, the i-gel did not show the better results for the insertion success rate when compared to other devices. CONCLUSION The findings of this meta-analysis indicated that inexperienced volunteers placed the i-gel more rapidly than other supraglottic airways with the exception of the LMA Supreme, aura-i, and air-Q in manikin studies. However, the quicker insertion time is clinically not relevant. The unapparent advantage regarding the insertion success rate and the inherent limitations of the simulation setting indicated that additional evidence is necessary to confirm these advantages of the i-gel in an emergency setting.
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Affiliation(s)
- Jiwon An
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Sang Beom Nam
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Jong Seok Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Jinae Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hanna Yoo
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Mi Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
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Hilton MT, Wayne M, Martin-Gill C. Impact of System-Wide King LT Airway Implementation on Orotracheal Intubation. PREHOSP EMERG CARE 2016; 20:570-7. [DOI: 10.3109/10903127.2016.1163446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schröder H, Zoremba N, Rossaint R, Deusser K, Stoppe C, Coburn M, Rieg A, Schälte G. Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study. BMJ Open 2016; 6:e010250. [PMID: 27008688 PMCID: PMC4800129 DOI: 10.1136/bmjopen-2015-010250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to compare visualisation of the vocal cords and performance of intubation by anaesthetists using four different laryngoscopes while wearing full chemical protective equipment. SETTING Medical simulation center of a university hospital, department of anaesthesiology. PARTICIPANTS 42 anaesthetists (15 females and 27 males) completed the trial. The participants were grouped according to their professional education as anaesthesiology residents with experience of <2 years or <5 years, or as anaesthesiology specialists with experience of >5 years. INTERVENTIONS In a manikin scenario, participants performed endotracheal intubations with four different direct and indirect laryngoscopes (Macintosh (MAC), Airtraq (ATQ), Glidescope (GLS) and AP Advance (APA)), while wearing chemical protective gear, including a body suit, rubber gloves, a fire helmet and breathing apparatus. PRIMARY AND SECONDARY OUTCOME MEASURES With respect to the manikin, setting time to complete 'endotracheal intubation' was defined as primary end point. Glottis visualisation (according to the Cormack-Lehane score (CLS) and impairments caused by the protective equipment, were defined as secondary outcome measures. RESULTS The times to tracheal intubation were calculated using the MAC (31.4 s; 95% CI 26.6 to 36.8), ATQ (37.1 s; 95% CI 28.3 to 45.9), GLS (35.4 s; 95% CI 28.7 to 42.1) and APA (23.6 s; 95% CI 19.1 to 28.1), respectively. Intubation with the APA was significantly faster than with all the other devices examined among the total study population (p<0.05). A significant improvement in visualisation of the vocal cords was reported for the APA compared with the GLS. CONCLUSIONS Despite the restrictions caused by the equipment, the anaesthetists intubated the manikin successfully within adequate time. The APA outperformed the other devices in the time to intubation, and it has been evaluated as an easily manageable device for anaesthetists with varying degrees of experience (low to high), providing good visualisation in scenarios that require the use of chemical protective equipment.
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Affiliation(s)
- H Schröder
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - N Zoremba
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Anesthesiology and Intensive Care, St Elisabeth Hospital, Gütersloh, Germany
| | - R Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - K Deusser
- Department of Internal Medicine, Aachen District Medical Center, Würselen, Germany
| | - C Stoppe
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Coburn
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - A Rieg
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - G Schälte
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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DuCanto J, Lungwitz Y, Koch A, Kähler W, Gessell L, Simanonok J, Roewer N, Kranke P, Winkler BE. Mechanical ventilation and resuscitation under water: Exploring one of the last undiscovered environments--A pilot study. Resuscitation 2015; 93:40-5. [PMID: 26051809 DOI: 10.1016/j.resuscitation.2015.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/05/2015] [Accepted: 05/26/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Airway management, mechanical ventilation and resuscitation can be performed almost everywhere--even in space--but not under water. The present study assessed the technical feasibility of resuscitation under water in a manikin model. METHODS Tracheal intubation was assessed in a hyperbaric chamber filled with water at 20 m of depth using the Pentax AWS S100 video laryngoscope, the Fastrach™ intubating laryngeal mask and the Clarus optical stylet with guidance by a laryngeal mask airway (LMA) and without guidance. A closed suction system was used to remove water from the airways. A test lung was ventilated to a maximum depth of 50 m with a modified Oxylator(®) EMX resuscitator with its expiratory port connected either to a demand valve or a diving regulator. Automated chest compressions were performed to a maximum depth of 50 m using the air-driven LUCAS™ 1. RESULTS The mean cumulative time span for airway management until the activation of the ventilator was 36 s for the Fastrach™, 57 s for the Pentax AWS S100, 53s for the LMA-guided stylet and 43 s for the stylet without LMA guidance. Complete suctioning of the water from the airways was not possible with the suction system used. The Oxylator(®) connected to the demand valve ventilated at 50 m depth with a mean ventilation rate of 6.5 min(-1) vs. 14.7 min(-1) and minute volume of 4.5 l min(-1) vs. 7.6 l min(-1) compared to the surface. The rate of chest compression at 50 m was 228 min(-1) vs. 106 min(-1) compared to surface. The depth of compressions decreased with increasing depth. CONCLUSION Airway management under water appears to be feasible in this manikin model. The suction system requires further modification. Mechanical ventilation at depth is possible but modifications of the Oxylator(®) are required to stabilize ventilation rate and administered minute volumes. The LUCAS™ 1 cannot be recommended at major depth.
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Affiliation(s)
- James DuCanto
- Department of Anesthesiology, Medical College of Wisconsin, Aurora St. Luke's Medical Center, Milwaukee, USA
| | | | - Andreas Koch
- German Naval Medical Institute, Kiel-Kronshagen, Germany
| | - Wataru Kähler
- German Naval Medical Institute, Kiel-Kronshagen, Germany
| | - Laurie Gessell
- Department of Hyperbaric Medicine, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Jack Simanonok
- Department of Hyperbaric Medicine, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Norbert Roewer
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Germany
| | - Peter Kranke
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Germany
| | - Bernd E Winkler
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Germany.
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Weaver KR, Barr GC, Long KR, Diaz L, Ratner AS, Reboul JP, Sturm DA, Greenberg MR, Dusza SW, Glenn-Porter B, Kane BG. Comparison of airway intubation devices when using a biohazard suit: a feasibility study. Am J Emerg Med 2015; 33:810-4. [PMID: 25817200 DOI: 10.1016/j.ajem.2015.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We set out to compare emergency medicine residents' intubating times and success rates for direct laryngoscopy (DL), GlideScope-assisted intubation (GS), and the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway with and without biohazard gear. METHODS Each resident passed through 2 sets of 3 testing stations (DL, GS, SALT) in succession, intubating Laerdal mannequin heads with the 3 modalities after randomization to start with or without biohazard gear. RESULTS Thirty-seven residents participated, and 27 were male (73%); 14 (37.8%) had prior experience intubating in biohazard suits. There was a statistically significant difference in those who had prior intubation experience between DL (37, 100%), GS (32, 86.5%), and SALT (12, 32.4%) (P < .001) and in median time to intubation (48 seconds, no suit; 57 seconds, with suits) (P = .03). There was no statistically significant difference between the overall times to intubate for the 3 devices. First-pass success was highest for DL (91.2%, no suit; 83.7%, suit) followed by GS (89%, no suit; 78.3%, suit) and SALT (51%, no suit; 67.6%, suit). CONCLUSION A minority of participants had prior experience intubating in biohazard suits. Use of biohazard suits extends time to successful intubation. There was no difference in time to intubation for the 3 devices, but first-pass success was highest for DL (with or without biohazard gear).
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Affiliation(s)
- Kevin R Weaver
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Gavin C Barr
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Kayla R Long
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Leonel Diaz
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Aaron S Ratner
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Jeffery P Reboul
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Douglas A Sturm
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Marna Rayl Greenberg
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103.
| | - Stephen W Dusza
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Bernadette Glenn-Porter
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Bryan G Kane
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
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Martin-Gill C, Prunty HA, Ritter SC, Carlson JN, Guyette FX. Risk factors for unsuccessful prehospital laryngeal tube placement. Resuscitation 2015; 86:25-30. [DOI: 10.1016/j.resuscitation.2014.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
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Ophir N, Ramaty E, Rajuan-Galor I, Rosman Y, Lavon O, Shrot S, Shiyovich A, Huerta-Hartal M, Kassirer M, Vaida S, Gaitini L. Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices. Am J Emerg Med 2014; 32:1445-9. [PMID: 25440004 DOI: 10.1016/j.ajem.2014.08.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Early respiratory support and airway (AW) control with endotracheal intubation (ETI) are crucial in mass toxicology events and must be performed while wearing chemical personal protective equipment (C-PPE). AIM The aim of this study is to evaluate the efficiency of AW control by using second-generation supraglottic AW devices (SADs) as compared with ETI and first-generation SAD while wearing C-PPE. METHODS This is a randomized crossover trial involving 117 medical practitioners. Four AW management devices were examined: endotracheal tube, the first-generation SAD, laryngeal mask AW unique and 2 second-generation SAD, the laryngeal tube suction disposable, and supreme laryngeal mask AW (SLMA). Primary end point measured were success or failure, number of attempts, and time needed to achieve successful device insertion. Secondary end point was a subjective appraisal of the AW devices by study population. RESULTS More attempts were required to achieve AW control with endotracheal tube, with and without C-PPE (P<.001). Time to achieve AW control with ETI was, on average, 88% longer than required with other devices and improved with practice. The mean times to achieve an AW were longer when operators were equipped with C-PPE as compared with standard clothing. Subjectively, difficulty levels were significantly higher for ETI than for all other devices (P<.0001). CONCLUSIONS When compared with ETI, the use of SADs significantly shortened the time for AW control while wearing C-PPE. Second-generation SAD were superior to laryngeal mask AW unique. These finding suggest that SADs may be used in a mass toxicology event as a bridge, until definite AW control is achieved.
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Affiliation(s)
- Nimrod Ophir
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Erez Ramaty
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | | | - Yossi Rosman
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
| | - Ophir Lavon
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Shai Shrot
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | | | - Michael Huerta-Hartal
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Kassirer
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sonia Vaida
- Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Luis Gaitini
- Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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De Oliveira GS, Glassenberg R, Chang R, Fitzgerald P, McCarthy RJ. Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation. Anaesthesia 2013; 68:1053-8. [PMID: 23952805 DOI: 10.1111/anae.12379] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/30/2022]
Abstract
We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.
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Affiliation(s)
- G S De Oliveira
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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