The Frankfurt COVid aErosol pRotEction Dome–COVERED–a consideration for personal protective equipment improvement and technical note

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

“…Authors recommend this device be used for all patients so that the learning curve can be reached before intubation has to perform actual critical COVID patients. Asokan and colleagues 37 Letter to the editor Technical report Acrylic AB (C-shaped curved side panels) with or without CPS N/A Description and experience in 50+ patients (no information provided) AB for airway management, including obese The C-shaped curved side panels are ergonomic for assistant use in obese; proved safe and effective Singh and colleagues 38 Letter to the editor Technical report CPS + frame with linear cuts N/A N/A CPS + frame for airway management Adaptable and lightweight; suggested cleaning before removal with alcohol-based disinfectant spray be done in the chamber with the patient breathing spontaneously through face mask and eyes closed Raimann and colleagues 39 Letter to the editor Simulation study Modified packaging tray used for heart–lung machine sets (cut/glued/polished) Two experiments (with/without barrier) Simulated cough in mannequin with a mucosal atomisation device filled with a fluorescent dye Inspective evaluation of fluorescent dye Effective and protective; limits spread of large droplets Martin and colleagues 40 Original article Modified packaging tray used for heart–lung machine sets (cut/glued/polished) N/A N/A Modified medical packaging (COVid aErosol pRotEction Dome—‘COVERED’) Economic; recycled material; help possible; need for training, limitations for other manoeuvres, advanced airway techniques, obese patients; intended as extra barrier to be added, and not to replace PPE Francom and colleagues 41 Original article Multicentre protocol description Complete CPS tent (bed/body/suspension over head and chin) + frames + smoke evacuator N/A Simulations and paediatric patients series Description of surgical procedures (suspected airway foreign body, microlaryngoscopy, and flexible/rigid bronchoscopy) in paediatric patients with tent in place The tents are sound to decrease aerosolisation and droplet contamination; little to no added risk to the patient, as the drapes may be rapidly removed; greatly perceived benefit to the safety of the anaesthesiologist, surgeon, and OT staff involved; tent does not replace the need for individual PPE; it can be used when PPE is scarce and preoperative testing is unavailable. Foster an...…”

“…6,15,42e44,54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5,9,12,15,17,23e29,31,33,34,38,39,41,42,44,46,47,52,54,56 acrylic aerosol boxes (19 reports), 4e6,8,11,15,16,18,19,22,24,35,36,43,45,51,53,57,58 and combinations of aerosol boxes and plastic wraps (eight reports). 6,8,13,15,32,37,43,49 Eleven reports included other types of barrier enclosures (modified incubator hood, 7 carton box, 8 acrylic panels, 50 surgical retractors, frames and anaesthetic poles, 21,42,44,48 external fixators, 14 suspension laryngoscopy support, 41,55 and modified packaging tray 40 ). In 10 cases, a smoke evacuator/aspirator was reported.…”

“…All were published between December 1, 2019 and May 27, 2020. There were 19 correspondences, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 16 letters to the editor, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 10 original articles, 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 three research letters, 34 , 50 , 51 one guideline, 52 one short recommendation, 53 one case report, 54 and one quality improvement study. 55 Of these reports, there were only six case reports or small case series.…”

“… 5 , 16 , 17 , 32 , 41 , 42 , 46 , 55 , 59 , 60 Sample sizes were often not given. 5 , 6 , 8 , 9 , 10 , 11 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 40 , 41 , 46 , 48 , 52 , 53 , 57 , 58 Cases of barrier-enclosure use with one mannequin or one human were noted in eight reports, 12 , 15 , 16 , 42 , 50 , 54 , 62 , 63 five cases in three reports, 22 , 24 , 44 and series of 25 or more cases in three reports. 37 , 45 , 47 The reported settings were simulations with mannequins in 20 cases, 4 , 5 , 6 , 11 , 12 , 13 , 16 , 19 ...…”

Novel Barrier Enclosure for Both Aerosol and Droplet Protection Model

“…This intubation box is similar in function to the COVid aErosol pRotEction Dome (“COVERED”) developed at the University HospitalFrankfurt, Germany with differences in design. 4 …”