Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study

Abstract

Background In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. Methods A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. Results There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). Conclusions The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

“…Additionally, simulation studies show that intubation is a safe procedure, provided that the healthcare professional is wearing PPE. However, to complicate the analysis, the wearing of PPE during the procedure may itself result in prolonged time to resuscitation [ 63 , 64 , 65 ].…”

Prevenção à exposição por aerossóis da COVID-19 durante a intubação orotraqueal

“…38 When dealing with preventive measures during OTI, studies mostly bring the use of protective barriers in association with the use of PPE: devices in box format, plastic and cover that cover the patients' headboard. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]32,33,35 The hypothesis raised is that only the use of PPE does not adequately protect, requiring the association of protective barriers to ensure safety. 36 Intubation boxes are acrylic boxes containing two where the allocates the arms for access to the airway, and an opening in its lower portion to attach the patients' head.…”

The Comparison of Duration Endotracheal Tube Insertion Using Aerosol Box And without Aerosol Box in Elective Surgery Patients in the Covid-19 Pandemic

“…The use of an aerosol box in the intubation procedure has been shown to increase the duration of the intubation procedure. 9 However, some literature mentions the benefits of protection and a reduction in the risk of contamination with the use of appropriate personal protective equipment along with the use of an aerosol box. This is in line with the research of Begley et al, who found that the average intubation with the aerosol box was 10 seconds longer than without the aerosol box (52.4 seconds compared to 42.9 seconds).…”