Does position of the patient adversely affect successful intubation whilst wearing CBRN-PPE?

Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear‐personal protective equipment: a manikin study

“…Although intubation offers numerous benefits, it remains a specialist Advanced Life Support skill that has been shown to be adversely affected by both the wearing of CBRN-PPE [6][7][8][9], and the position of the patient [10]. Furthermore, success rates vary between professional groups [11].…”

What is the optimal position of an intubator wearing CBRN-PPE when intubating on the floor: A manikin study

“…These intubation positions have previously been described 14,15 and were all noted by Castle et al 8 to be adopted by various clinicians while attempting to intubate wearing CBRN-PPE.…”

“…This methodology has previously been described. 8 A homogenous group of 48 final year paramedic students from the Durban University of Technology, Republic of South Africa (DUT), were recruited as subgroup analysis by Castle et al 18 demonstrated that professional groups varied in their performance of intubating on the floor while wearing CBRN-PPE. Hoyle et al 11 demonstrated similar findings when clinicians wore normal clothing.…”

“…6,7 Airway management will be further complicated by the need for rescue personnel to wear CBRN personnel protective equipment (CBRN-PPE). Castle et al 8 recently demonstrated that intubation on the floor, while wearing CBRN-PPE, was more difficult resulting in prolonged intubation attempts with a higher failure rate. This was regardless of the position on the floor that the clinician adopted.…”

“…The laryngeal mask airway (LMA) is easy to insert while wearing CBRN-PPE 9,10 and insertion is not affected by the position of the patient. 8,11 However, the cuffed endotracheal tube (ETT) provides a number of benefits; to include better airway protection and the ability to ventilate against high airway pressures. Once intubated the risk of continued exposure to the CBRN agent can be further mitigated either by ventilation via a closed circuit if 100% oxygen is used or by using a CBRN filter attached to a ventilator or bag-valve-mask device (BVM).…”