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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
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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
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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