Intubation performance using different laryngoscopes while wearing chemical protective equipment: A manikin study

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.

Keywords

Author Keywords

Not provided

Index Keywords

adult clinical competence female human male medical education procedures Humans Internship and Residency Article Vocational education education Germany residency education clinical practice scoring system comparative study outcome assessment pilot study simulation Pilot Projects clinical trial university hospital Hospitals, University classification anesthesiology time factor Time Factors standards anesthesist audiovisual equipment breathing circuit endotracheal intubation endotracheal tube stylet glottis glove helmet laryngoscope protective clothing rigid laryngoscope videolaryngoscope vocal cord equipment design manikin Intubation, Intratracheal Laryngoscopes Manikins

Author Affiliations

Department of Anesthesiology, Uniklinik RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany, Department of Intensive Care and Intermediate Care, Uniklinik RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany

Department of Anesthesiology, Uniklinik RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany, Department of Anaesthesia and Intensive Care, St. Elisabeth-Hospital, Gutersloh, Germany

Department of Anesthesiology, Uniklinik RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany

Department of Internal Medicine, Medical Centre Aachen, Wurselen, Germany

Funding & Acknowledgements

No funding information

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Intubation performance using different laryngoscopes while wearing chemical protective equipment: A manikin study

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