Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin.
INTRODUCTION
Following a chemical, biological, radiation and nuclear (CBRN) incident, prompt establishment of an advanced airway is required for patients with respiratory failure within the warm zone, while wearing personal protective equipment (PPE). Previous studies reported that intubation attempts were prolonged, and incidence of esophageal intubation was increased with conventional Macintosh laryngoscope (McL), while wearing CBRN-PPE. Pentax-AWS (AWS), a recently introduced portable video laryngoscope, was compared with the McL to test its utility for tracheal intubation while wearing CBRN-PPE.


METHODS
31 participants performed unsuited and suited intubations on an advanced life support simulator. The sequence of intubating devices and PPE wearing were randomised. Time to complete tracheal intubation (primary end point), time to see the vocal cords, overall success rate, percentage of glottic opening, dental compression and ease of intubation were measured.


RESULTS
Suited intubations required significantly longer time to complete intubation than unsuited intubations, in both McL and AWS (22.2 vs 26.4 s, 14.2 vs 18.2 s, respectively). However, suited AWS intubations required shorter time to complete tracheal intubation than unsuited McL intubations (18.2 vs 22.2 s). In secondary outcomes, moreover, suited intubations using the AWS compared favourably with unsuited intubations using the McL.


CONCLUSIONS
Although the CBRN-PPE adversely affected time required to complete tracheal intubation with the AWS, suited intubations using the AWS were even superior to unsuited intubations using the McL. The AWS should be a promising device to perform tracheal intubation while wearing the CBRN-PPE.
['Shin|Dong Hyuk|DH|', 'Choi|Pil Cho|PC|', 'Na|Ji Ung|JU|', 'Cho|Jun Hwi|JH|', 'Han|Sang Kuk|SK|']
D000328:Adult D018592:Cross-Over Studies D004636:Emergency Service, Hospital D004867:Equipment Design D005260:Female D015386:Hazardous Substances D007722:Health Knowledge, Attitudes, Practice D006801:Humans D007442:Intubation, Intratracheal D020704:Laryngoscopes D007828:Laryngoscopy D008297:Male D008348:Manikins D016544:Patient Simulation D011481:Protective Clothing D015203:Reproducibility of Results D013647:Task Performance and Analysis D013997:Time Factors
intubation manikin CBRN airway resuscitation toxicology video laryngoscopy