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Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study

Published online by Cambridge University Press:  11 May 2015

Sara J. Aberle ,
Benjamin J. Sandefur ,
Kharmene L. Sunga ,
Ronna L. Campbell ,
Christine M. Lohse ,
Henrique Alecastro Puls ,
Sarah Laudon  and
Matthew D. Sztajnkrycer
Sara J. Aberle
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Benjamin J. Sandefur
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Kharmene L. Sunga
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Ronna L. Campbell
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Christine M. Lohse
Affiliation:
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota USA
Henrique Alecastro Puls
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Sarah Laudon
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
Matthew D. Sztajnkrycer*
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
*
Correspondence: Matthew D. Sztajnkrycer, MD, PhD Department of Emergency Medicine Mayo Clinic GE-GR-G410 200 1st Street SW Rochester, Minnesota 55905 USA E-mail: [email protected]
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Abstract

Introduction

Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.

Methods

Post-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.

Results

Twenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.

Conclusion

The time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.

AberleSJ , SandefurBJ , SungaKL , CampbellRL , LohseCM , Alecastro PulsH , LaudonS , SztajnkrycerMD . Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study. Prehosp Disaster Med. 2015;30(3):1–5.

Keywords

direct laryngoscopyhazardous materialspersonal protective equipmentvideo laryngoscopy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 259 - 263
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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