Endotracheal tube fixation time: a comparison of three fixation methods in a military field scenario

Abstract

IntroductionEndotracheal intubation is required in many emergency, trauma and prehospital scenarios. Endotracheal tube (ETT) fixation must be stable and quick to apply to enable rapid evacuation and patient transport. This study compares performance times of three common ETT securement techniques which are practical for out-of-hospital and combat scenarios.MethodsWe compared the time required by military medics to complete ETT fixation in three techniques—fixation of a wide gauze roll wrapped twice around the head and tied twice around the ETT (GR), using a Thomas Tube Holder (TH) and using a pre-tied non-adhesive tape (PT). 300 military medics were randomised to apply one technique each on a manikin, and time to completion was recorded.Results300 ETTs were successfully fixated by 300 military medics. Median times to complete ETT fixation by PT and TH techniques were 24 s (IQR (19 to 31) and (IQR 20 to 33), respectively). Both were significantly shorter to apply than the GR technique, with a median time of 57 s (IQR 47 to 81), p<0.001.ConclusionsIn time critical situations such as combat, severe trauma, mass casualties and whenever rapid evacuation might improve the clinical outcome, using a faster fixation technique such as Thomas Tube Holder or a pre-tied non-adhesive tape might enable faster evacuation than the use of traditional endotracheal tube fixation techniques.

Comparison of the effectiveness of endotracheal tube holder with the conventional method in a manikin model

“…In emergency situations such as prehospitalization trauma care, cardiac arrest, and mass casualty incidents, the fastest fixation technique enables the fastest evacuation. [ 17 ]…”

Effects of endotracheal tube fixation methods on haemodynamic parameters during endotracheal suction: A single‐blind non‐randomized clinical trial study

“…Past studies showed that tube holders caused less ET movement, displacement, and unplanned extubation than plasters and gauze patches for ET fixation (Buckley et al, 2016; Fisher et al, 2014). Studies on the use of tube holders for the fixation of ET are mostly focused on the reliability of the method (Buckley et al, 2016; Fisher et al, 2014; Komasawa et al, 2015); on the effects of pressure injuries related to pressure caused by ET (Hampson et al, 2018; Hanonu & Karadag, 2016; Kuniavsky et al, 2020); and on comparison of fixation time of ET (Epstein et al, 2020; Suttapanit et al, 2020). However, the effects on the haemodynamic parameter changes due to ET movement during ES have not been investigated.…”