Impact of Chemical, Biological, Radiation, and Nuclear Personal Protective Equipment on the performance of low- and high-dexterity airway and vascular access skills

Castle, Nick; Owen, Robert; Hann, Mark; Clark, S. M.; Reeves, David; Gurney, I

doi:10.1016/j.resuscitation.2009.08.001

Cited by 62 publications

(90 citation statements)

References 27 publications

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“…Participants inserted each supraglottic airway device in a randomised order, whilst wearing CBRN-PPE and standard ambulance uniform, with each participant acting as their own control. We recruited a group of comparable paramedic students, as we have previously noted inter-professional differences with regard to inserting LMAs [9]. All participants had been assessed as competent in airway management, having completed Durban University's 2-week airway module consisting of fifteen, 8-h anaesthetic attachments, and having attended a compulsory 4-h airway workshop before data collection, to optimise familiarity with all the devices being evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

“…Despite there being numerous supraglottic airways [12], to date, only the LMA [7,9], the intubating LMA TM (LMA Company, Jersey, Channel Isles, UK) [13] and the cuffed oropharyngeal airway (COPA; Mallinckrodt Medical, Athlone, Ireland) [14] have been evaluated for use whilst wearing CBRN-PPE. Recently, however, Barns et al [15] evaluated the Laryngeal Tube TM (VBM Medizintechnik GmbH, Sulz, Germany) for use whilst wearing fire rescue equipment, but not specifically CBRN-PPE.…”

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confidence: 99%

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

2011

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Summary Six different supraglottic airway devices: Combitube™, laryngeal mask airway, intubating laryngeal mask airway (Fastrach™), i‐gel™, Laryngeal Tube™ and Pro‐Seal™ laryngeal mask airway were assessed by 58 paramedic students for speed and ease of insertion in a manikin, whilst wearing either chemical, biological, radiation, nuclear‐personal protective equipment (CBRN‐PPE) or a standard uniform. All devices took significantly longer to insert when wearing CBRN‐PPE compared with standard uniform (p < 0.001). In standard uniform, insertion time was shorter than 45 s in 90% of attempts for all devices except the Combitube, for which 90% of attempts were completed by 53 s. Whilst wearing CBRN‐PPE the i‐gel was the fastest device to insert with a mean (SD (95% CI)) insertion time of 19 (8 (17–21))s, p < 0.001, with the Combitube the slowest with mean (65 (23 (59–71))s. Wearing of CBRN‐PPE has a negative impact on supraglottic airway insertion time. You can respond to this article at http://www.anaesthesiacorrespondence.com

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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

2011

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“…L'atelier comprenait un garrot, des compresses stériles 5 cm × 5 cm, un flacon d'antiseptique, des cathéters taille 18 G et un kit de perfusion préparé adapté à un sérum salé 0,9 % de 500 ml. Pour la pose de KTIO étaient utilisés un tibia de perfusion de type Laerdal ® , des compresses stériles 5 cm × 5 cm, un flacon d'antiseptique, une perceuse EZ-IO™ Vidacare (Teleflex Medical Europe, Dublin, Irlande), une aiguille taille adulte calibre 15 G, une seringue de 20 ml préremplie, un Les études ayant analysé la difficulté des gestes techniques liée au port de tenues de protection des risques radiologiques ou chimiques rapportent une augmentation de délai d'insertion d'accès veineux de 50 à 100 % [7]. En supposant l'hypothèse d'un délai d'accès veineux sur mannequin sans habillage de 70 ± 30 secondes [15], 22 participants étaient nécessaires pour démontrer une augmentation significative du délai d'accès veineux périphérique de plus de 50 % en tenue de protection individuelle Ebola pour une puissance de 80 %.…”

Section: Matériel Et Méthodesunclassified

“…Plusieurs études ont démontré que le port de tenues de protection individuelle pouvait augmenter les contraintes physiques et la difficulté de réalisation de gestes techniques de médecine d'urgence [7][8][9]. La plupart de ces études concernent toutefois les équipements de protection individuelle (EPI) face aux risques nucléaires, radiologiques, biologiques ou chimiques (NRBC).…”

Section: Introductionunclassified

Faisabilité des gestes d’urgence en tenue de protection individuelle du virus Ebola : pose d’abords vasculaires et contrôle des voies aériennes supérieures sur mannequin

Bosc

Sanchez

Carrié

et al. 2016

Ann. Fr. Med. Urgence

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Objectif : Les équipes prenant en charge un patient suspect de virose Ebola sont tenues au port d'équipements de protection individuelle (EPI) susceptibles d'entraver la dextérité des opérateurs. L'objectif principal est d'étudier l'impact des EPI Ebola sur la difficulté et le délai de réalisa-tion des gestes d'urgence. Matériel et méthodes : Cette étude observationnelle monocentrique croisée incluait 22 médecins urgentistes, réanima-teurs ou infirmiers -anesthésistes volontaires devant réali-ser cinq ateliers sur mannequin avec ou sans port d'EPI Ebola selon une séquence prédéterminée : voie veineuse périphérique (VVP), cathéter intraosseux (KTIO), intubation avec et sans Eschmann ou après pose de LMA-Fastrach™. Le critère de jugement principal était le délai de réalisation des gestes techniques avec et sans port d'EPI. Résultats : Le port de l'EPI n'augmente pas le taux d'échec de chaque geste technique mais augmente significativement les délais d'intubation simple (29 vs 36 secondes ; p < 0,01), d'intubation avec Eschmann (38 vs 45 secondes ; p = 0,03) et l'intubation au LMA-Fastrach™ (39 vs 45 secondes ; p < 0,001). Le port d'EPI Ebola augmentait la difficulté ressentie pour la pose d'abords vasculaires sans augmenter le taux d'échec ni modifier les délais de pose de VVP. Le recours au KTIO était plus rapide que la pose de VVP sans (67 vs 88 secondes ; p = 0,02) et avec tenue (78 vs 101 secondes ; p < 0,01). Conclusion : Le port de l'EPI n'entraîne qu'un impact modéré sur la dextérité des gestes techniques en situation d'urgence. Ces résultats doivent être confortés par des études cliniques. Mots clés Ebola · Équipement de protection individuelle · Voie veineuse · Cathéter intraosseux · IntubationAbstract Background: Emergency or critical care physicians dealing with patients with Ebola virus disease (EVD) have to handle technical skills while wearing specific personal protective equipment (PPE). We thus aimed to assess the impact of Ebola-PPE for the completion of five emergency technical skills on training manikin. Methods: Twenty-two volunteers were recruited to perform intubation with and without Eschmann tube, LMAFastrach™ placement, insertion of an intravenous (IV) cannula and intra-osseous (IO) during a predefined sequence. The main endpoint was the time for completion of the five technical skills on manikin with and without Ebola-PPE in a random order. Results: The success rate of the five technical skills whilst wearing Ebola-PPE was equivalent but significantly increased the time for simple intubation (29 vs 36 s; P < 0.01), intubation with Eschmann (38 vs 45 s ; P = 0.03) and LMA-Fastrach™ placement (39 vs 45 s; P < 0.001). Wearing Ebola-PPE increased difficulty for vascular access without increasing the failure rate or change the time of installation VVP. IO insertion was faster than IV insertion access without PPE (67 vs 88 s; P = 0.02) and with PPE (78 vs 101 s; P = 0.007).

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Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Verbeek

Ijaz

Mischke

et al. 2016

Cochrane Database of Systematic Reviews

179

183

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We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. We also found very low quality evidence that double gloving and CDC doffing guidance appear to decrease the risk of contamination and that more active training in PPE use may reduce PPE and doffing errors more than passive training. However, the data all come from single studies with high risk of bias and we are uncertain about the estimates of effects.We need simulation studies conducted with several dozens of participants, preferably using a non-pathogenic virus, to find out which type and combination of PPE protects best, and what is the best way to remove PPE. We also need randomised controlled studies of the effects of one type of training versus another to find out which training works best in the long term. HCWs exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection.

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Impact of Chemical, Biological, Radiation, and Nuclear Personal Protective Equipment on the performance of low- and high-dexterity airway and vascular access skills

Cited by 62 publications

References 27 publications

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

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

Faisabilité des gestes d’urgence en tenue de protection individuelle du virus Ebola : pose d’abords vasculaires et contrôle des voies aériennes supérieures sur mannequin

Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

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