Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-29T02:20:59.640Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of Personal Protection Equipment on Intubation Times

Published online by Cambridge University Press:  27 May 2021

Donald Doukas Open the ORCID record for Donald Doukas [Opens in a new window] ,
Bonnie Arquilla ,
Pinchas Halpern ,
Mark Silverberg  and
Richard Sinert
Donald Doukas*
Affiliation:
Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New YorkUSA
Bonnie Arquilla
Affiliation:
Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New YorkUSA
Pinchas Halpern
Affiliation:
Tel Aviv University Sackler and Tel Aviv Medical Center, Division of Emergency Medicine, Tel Aviv, Israel
Mark Silverberg
Affiliation:
Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New YorkUSA
Richard Sinert
Affiliation:
Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New YorkUSA
*
Correspondence: Donald Doukas, MD, 451 Clarkson Ave., Brooklyn, New York11203USA, E-mail: Donald.Doukas@Downstate.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Hazardous material (HAZMAT) protocols require health care providers to wear personal protective equipment (PPE) when caring for contaminated patients. Multiple levels of PPE exist (level D - level A), providing progressively more protection. Emergent endotracheal intubation (ETI) of victims can become complicated by the cumbersome nature of PPE.

Study Objective:

The null hypothesis was tested that there would be no difference in time to successful ETI between providers in different types of PPE.

Methods:

This randomized controlled trial assessed time to ETI with differing levels of PPE. Participants included 18 senior US Emergency Medicine (EM) residents and attendings, and nine US senior Anesthesiology residents. Each individual performed ETI on a mannequin (Laerdal SimMan Essential; Stavanger, Sweden) wearing the following levels of PPE: universal precautions (UP) controls (nitrile gloves and facemask with shield); partial level C (PC; rubber gloves and a passive air-purifying respirator [APR]); and complete level C (CC; passive APR with an anti-chemical suit). Primary outcome measures were the time in seconds (s) to successful intubation: Time 1 (T1) = inflation of the endotracheal tube (ETT) balloon; Time 2 (T2) = first ventilation. Data were reported as medians with Interquartile Ranges (IQR, 25%-75%) or percentages with 95% Confidence Intervals (95%, CI). Group comparisons were analyzed by Fisher’s Exact Test or Kruskal-Wallis, as appropriate (alpha = 0.017 [three groups], two-tails). Sample size analysis was based upon the power of 80% to detect a difference of 10 seconds between groups at a P = .017; 27 subjects per group would be needed.

Results:

All 27 participants completed the study. At T1, there was no statistically significant difference (P = .27) among UP 18.0s (11.5s-19.0s), PC 21.0s (14.0s-23.5s), or CC 17.0s (13.5s-27.5s). For T2, there was also no significant (P = .25) differences among UP 24.0s (17.5s-27.0s), PC 26.0s (21.0s-32.0s), or CC 24.0s (19.5s-33.5s).

Conclusion:

There were no statistically significant differences in time to balloon inflation or ventilation. Higher levels of PPE do not appear to increase time to ETI.

Keywords

decontaminationemergency medicinehazardous materials (HAZMAT)intubationpersonal protective equipment
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 4 , August 2021 , pp. 375 - 379
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ekzayez, A, Flecknoe, MD, Lillywhite, L, Patel, P, Papamichail, A, Elbahtimy, H. Chemical weapons and public health: assessing impact and responses. J Public Health (Oxf). 2020;42(3):e334–e342.CrossRefGoogle ScholarPubMed
Watson, CM, Barnett, DJ, Thompson, CB, et al. Characterizing public health emergency perceptions and influential modifiers of willingness to respond among pediatric healthcare staff. Am J Disaster Med. 2011;6(5):299–308.CrossRefGoogle ScholarPubMed
Institute of Medicine (US) Committee on Personal Protective Equipment for Healthcare Personnel to Prevent Transmission of Pandemic Influenza and Other Viral Respiratory Infections. “Using PPE: Individual and Organizational Issues.” In: Larson EL, Liverman CT, (eds). Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010. Washington, DC USA: National Academies Press; 2011:4.Google Scholar
Grillet, G, Marjanovic, N, Diverrez, JM, Tattevin, P, Tadie, JM, L’Her, E. Intensive care medical procedures are more complicated, more stressful, and less comfortable with Ebola personal protective equipment: a simulation study. J Infect. 2015;71(6):703–706.CrossRefGoogle ScholarPubMed
Flaishon, R, Sotman, A, Ben-Abraham, R, Rudick, V, Varssano, D, Weinbroum, AA. Antichemical protective gear prolongs time to successful airway management: a randomized, crossover study in humans. Anesthesiology. 2004;100(2):260–266.CrossRefGoogle ScholarPubMed
Scott Taylor, R, Pitzer, M, Goldman, G, Czysz, A, Simunich, T, Ashurst, J. Comparison of intubation devices in level C personal protective equipment: a cadaveric study. Am J Emerg Med. 2018;36(6):922–925.CrossRefGoogle Scholar
Lee, J, Kim, JY, Kang, SY, Kwak, HJ, Lee, D, Lee, SY. Stylet angulation for routine endotracheal intubation with McGrath video laryngoscope. Medicine (Baltimore). 2017;96(7):e6152.CrossRefGoogle Scholar
Weaver, KR, Barr, GC, Long, KR, et al. Comparison of airway intubation devices when using a biohazard suit: a feasibility study. Am J Emerg Med. 2015;33(6):810–814.CrossRefGoogle ScholarPubMed
Aleksandrowicz, S, Madziala, M. Blind intubation through the supraglottic airway laryngopharyngeal tube with a biohazard suit. Am J Emerg Med. 2016;34(10):2040.CrossRefGoogle ScholarPubMed
Garner, A, Laurence, H, Lee, A. Practicality of performing medical procedures in chemical protective ensembles. Emerg Med Australas. 2004;16(2):108–113.Google ScholarPubMed
Castle, N, Owen, R, Clark, S, Hann, M, Reeces, D, Gurney, I. Comparison of techniques for securing the endotracheal tube while wearing chemical, biological, radiological, or nuclear protection: a manikin study. Prehosp Disaster Med. 2010;25(6):589–594.CrossRefGoogle ScholarPubMed
Watson, CM, Duval-Arnould, JM, McCrory, MC, et al. Simulated pediatric resuscitation use for personal protective equipment adherence measurement and training during the 2009 influenza (H1N1) pandemic. Jt Comm J Qual Patient Saf. 2011;37(11):515–523.Google ScholarPubMed