This relatively small study (N=19) randomised emergency resident trainees (14) and first responders (5) to cadaveric intubation with and without 'Level C PPE':

Level C PPE typically includes a full face mask with air respirator, a hooded chemical resistant clothing, inner and outer gloves and chemical resistant boots with covers.

First-pass intubation success was significant lower (58% vs 96%) while wearing PPE than without. Subjects identified the visibility impact of wearing protective hoods as the most common impediment to intubation.

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• R Scott Taylor, Matthew Pitzer, Grayson Goldman, Augusta Czysz, Thomas Simunich, and John Ashurst.
• Duke Lifepoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, PA, United States. Electronic address: RTaylor@conemaugh.org.
• Am J Emerg Med. 2018 Jun 1; 36 (6): 922-925.

BackgroundWith the advancement of chemical, biological and nuclear warfare and the reemergence of infectious diseases, the possibility of intubating in personal protective equipment has become increasingly more real to the emergency physician. Human cadaveric models have been found to simulate real world conditions better than mannequins. The aim of the study was to determine the first pass success rate and average time to successful intubation while wearing Personal Protective Equipment (PPE). Secondarily, subjects were asked to rank their choice of a primary and back up device, as well as the most common encountered barriers using PPE.MethodsEmergency medicine residents and pre-hospital providers were enrolled in a double randomized sequence to either intubation with direct laryngoscopy (DL), video laryngoscopy (VL), or the Supraglottic Airway Laryngopharyngeal Tube (SALT) in a cadaveric model while wearing level C PPE or without PPE.ResultsFirst pass success rate was 96% without PPE and 58% while wearing PPE when all devices were considered (p≤0.001). Time to intubation while wearing PPE was 35.0s while no PPE was 22.2s (p=0.012). While wearing PPE both DL and VL were found to allow for a faster intubation as compared to the SALT (23.0s and 18.8s; p=0.002 and p=0.006 respectively). No statistical difference was noted in intubations without PPE. Participants indicated the most common barrier to successful intubation included visibility while wearing hoods (73.7%). Furthermore, 52.6% of participants indicated they would choose DL as the primary method to intubate with if wearing PPE while 47.4% would choose VL.ConclusionThere is a statistically significant difference in first pass success and time to successful intubation while wearing and not wearing PPE in human cadaveric models.Copyright © 2017. Published by Elsevier Inc.

This article appears in the collection: Anaesthesiology, Personal Protective Equipment (PPE) and COVID.

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