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Emergency Airway Management in a Simulation of Highly Contagious Isolated Patients: Both Isolation Strategy and Device Type Matter

Published online by Cambridge University Press:  08 February 2018

Eike Plazikowski ,
Robert Greif ,
Jonas Marschall ,
Tina H. Pedersen ,
Maren Kleine-Brueggeney ,
Roland Albrecht  and
Lorenz Theiler
Eike Plazikowski
Affiliation:
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
Robert Greif
Affiliation:
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
Jonas Marschall*
Affiliation:
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
Tina H. Pedersen
Affiliation:
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
Maren Kleine-Brueggeney
Affiliation:
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
Roland Albrecht
Affiliation:
Swiss Air Rescue, REGA, Zürich, Switzerland
Lorenz Theiler
Affiliation:
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland Swiss Air Rescue, REGA, Zürich, Switzerland
*
Address correspondence to Jonas Marschall, MD, Department of Infectious Diseases, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland (jonas.marschall@insel.ch).
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Abstract

OBJECTIVE

To compare 6 airway-management devices in 3 isolation scenarios regarding their effect on airway management: portable isolation unit (PIU), personal protective equipment (PPE), and standard protection measures

METHODS

In total, 30 anesthesiologists working in emergency medical services performed airway management on mannequins in 3 isolation settings using 6 different airway management devices (in random order): (1) standard Macintosh laryngoscope; (2) Airtraq SP-video-laryngoscope; (3) i-gel; (4) LMA-Fastrach; (5) Ambu fiberoptic-aScope; and (6) Melker cricothyrotomy-set. Each was assessed regarding time-to-ventilate (primary outcome) and rating of difficulty handling the device.

RESULTS

In 86% (standard protection) and 85% (PPE) of attempts, airway management was achieved in <60 seconds, irrespective of the device used. In the PIU setting, only 69% of attempts succeeded within this time frame (P<.05). Median time-to-ventilate was shorter for standard protection (23 seconds) and PPE (25 seconds) compared to the PIU (38 seconds; P<.001). In the PIU setting, the fiberscope took the longest (median, 170 seconds), while i-gel was the quickest (median, 13 seconds). The rating of difficulty (visual analogue scale [VAS], 0–100) differed significantly between the isolation scenarios: Airway management was most difficult with PIU (VAS, 76), followed by PPE (VAS, 35), and standard protection (VAS, 9) (P<.01).

CONCLUSION

Wearing PPE produced similar times-to-ventilate as standard protection among anesthesiologists, but it was subjectively rated more difficult. The portable isolation unit permitted acceptable times-to-ventilate when excluding fiberscope and cricothyrotomy. Supraglottic airway devices allowed the fastest airway management in all isolation scenarios, thus being highly recommendable if a portable isolation unit is used and emergency airway management becomes necessary.

Infect Control Hosp Epidemiol 2018;39:145–151

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 2 , February 2018 , pp. 145 - 151
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: The results of this study were previously presented, in part, at the Euroanaesthesia Congress (ESA) in London, England, on May XX, 2016, and at the European Society for Emergency Medicine (EUSEM) conference in Vienna, Austria, on May 28 and October 3, 2016.

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