Will Protective Innovations Like the “Airway Box” Become Routine Practice After the Pandemic?: An Opinion Survey

Abstract

Background Tracheal intubation carries an elevated risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the generation of aerosols containing high concentrations of the virus. An airway box was designed to mitigate the exposure of healthcare professionals performing intubations. Aim We evaluated usability and sustainability in the routine practice of the "airway box" as a protective device during high-risk airway procedures. Materials and methods After institutional review board approval, clinicians were educated on using the device through simulation, intranet learning modules, and emailed resources. The airway box was made available in the emergency department, critical care units, perioperative area, and operating rooms. QR codes affixed to the box, emailed, and displayed in common areas provided easy access to complete a REDcap survey (Vanderbilt University Nashville, USA) eliciting providers' experience. Data was collected and analyzed between April 1 and July 31, 2020, on REDcap, and the results were analyzed. Results 687 emergent intubations took place. 232 were performed by anesthesiologists, 315 by emergency department providers, and 140 by critical care specialists. 39 surveys were completed, 29 from intubations in the operating room, three from the critical care units, five from interventional radiology suites, and two perioperatively. Providers found the device to be readily available, with a score of 4.51/5, and the majority of providers, 60%, found the device easy to use, rating it either a 4 or 5 out of 5. Providers acquired a mean Mallampati score of 1.75 and 1.40 mean laryngoscopic grade view. Conclusion Intubation boxes may effectively mitigate high-risk viral exposure during airway procedures. Survey responses show that devices were easy to use and did not significantly affect visualization of the airway. Similar to mask use, enclosure devices in clinical practice could become a vital part of medical protective equipment even after the SARS-CoV-2 pandemic if they are effectively implemented.

Evaluating the Use of an Aerosol Box During Simulated Intubations

“…Additionally, the structured qualitative evaluation conducted through the use of a questionnaire identifies specific concerns based on direct provider experience. Interestingly, a study by Ellison et al, which evaluated the use of an aerosol box in clinical use for emergent intubations, reported that the majority of practitioners who used the device found it easy to use, although it was rarely used despite being a readily available option [20].…”

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

“…The aerosol box was designed to mitigate HCP infection by providing a physical barrier to minimize exposure to aerosols . This study showed that aerosol box use reduces surface contamination on the PPE (torso and face) of airway practitioners after performing AGMPs.…”

“…The aerosol box has been implemented by some hospitals worldwide for management of COVID-19 patients who are critically ill . Studies demonstrate that aerosol box use potentially reduces spread of aerosolized particles, but is often associated with technical challenges .…”

“…The aerosol box has been implemented by some hospitals worldwide for management of COVID-19 patients who are critically ill. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Studies demonstrate that aerosol box use potentially reduces spread of aerosolized particles, 20 , 21 but is often associated with technical challenges. 22 , 23 , 24 , 25 Simulation-based studies describe delayed time to intubation with aerosol box use, but clinical studies largely demonstrate no difference in intubation times.…”

A Dome-Shaped Aerosol Box for Protection During a Pandemic

“…However, in emergency and intensive care, these procedures are often essential for patient treatment and survival, and any delay in their implementation would be a detriment to the patients. Since the beginning of the COVID-19 pandemic, there have been many reports of the use of aerosol boxes, with the aim being to reduce aerosol dispersion, thereby preventing secondary infections among HCPs [2][3][4].…”