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The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study.
Anaesthesia. 2020 08; 75(8):1014-1021.A

Abstract

The coronavirus disease 2019 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use during tracheal intubation. We evaluated the impact of two aerosol boxes (an early-generation box and a latest-generation box) on intubations in patients with severe coronavirus disease 2019 with an in-situ simulation crossover study. The simulated process complied with the Safe Airway Society coronavirus disease 2019 airway management guidelines. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. All intubations were performed by specialist (consultant) anaesthetists and video recorded. Twelve anaesthetists performed 36 intubations. Intubation time with no aerosol box was significantly shorter than with the early-generation box (median (IQR [range]) 42.9 (32.9-46.9 [30.9-57.6])s vs. 82.1 (45.1-98.3 [30.8-180.0])s p = 0.002) and the latest-generation box (52.4 (43.1-70.3 [35.7-169.2])s, p = 0.008). No intubations without a box took more than 1 min, whereas 14 (58%) intubations with a box took over 1 min and 4 (17%) took over 2 min (including one failure). Without an aerosol box, all anaesthetists obtained first-pass success. With the early-generation and latest-generation boxes, 9 (75%) and 10 (83%) participants obtained first-pass success, respectively. One breach of personal protective equipment occurred using the early-generation box and seven breaches occurred using the latest-generation box. Aerosol boxes may increase intubation times and therefore expose patients to the risk of hypoxia. They may cause damage to conventional personal protective equipment and therefore place clinicians at risk of infection. Further research is required before these devices can be considered safe for clinical use.

Authors+Show Affiliations

Intensive Care Unit, Cabrini Hospital, Malvern, Vic, Australia. 2nd General Health Battalion, Australian Army, Brisbane, QLD, Australia.Intensive Care Unit, Cabrini Hospital, Malvern, Vic, Australia.Alfred Health, Melbourne, Vic, Australia. School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia.Intensive Care Unit, Cabrini Hospital, Malvern, Vic, Australia. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32397008

Citation

Begley, J L., et al. "The Aerosol Box for Intubation in Coronavirus Disease 2019 Patients: an In-situ Simulation Crossover Study." Anaesthesia, vol. 75, no. 8, 2020, pp. 1014-1021.
Begley JL, Lavery KE, Nickson CP, et al. The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study. Anaesthesia. 2020;75(8):1014-1021.
Begley, J. L., Lavery, K. E., Nickson, C. P., & Brewster, D. J. (2020). The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study. Anaesthesia, 75(8), 1014-1021. https://doi.org/10.1111/anae.15115
Begley JL, et al. The Aerosol Box for Intubation in Coronavirus Disease 2019 Patients: an In-situ Simulation Crossover Study. Anaesthesia. 2020;75(8):1014-1021. PubMed PMID: 32397008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study. AU - Begley,J L, AU - Lavery,K E, AU - Nickson,C P, AU - Brewster,D J, Y1 - 2020/06/01/ PY - 2020/05/07/accepted PY - 2020/5/13/pubmed PY - 2020/7/25/medline PY - 2020/5/13/entrez KW - COVID-19 KW - PPE KW - RSI KW - aerosol box KW - barrier device KW - intubation KW - personal protective equipment KW - rapid sequence induction SP - 1014 EP - 1021 JF - Anaesthesia JO - Anaesthesia VL - 75 IS - 8 N2 - The coronavirus disease 2019 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use during tracheal intubation. We evaluated the impact of two aerosol boxes (an early-generation box and a latest-generation box) on intubations in patients with severe coronavirus disease 2019 with an in-situ simulation crossover study. The simulated process complied with the Safe Airway Society coronavirus disease 2019 airway management guidelines. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. All intubations were performed by specialist (consultant) anaesthetists and video recorded. Twelve anaesthetists performed 36 intubations. Intubation time with no aerosol box was significantly shorter than with the early-generation box (median (IQR [range]) 42.9 (32.9-46.9 [30.9-57.6])s vs. 82.1 (45.1-98.3 [30.8-180.0])s p = 0.002) and the latest-generation box (52.4 (43.1-70.3 [35.7-169.2])s, p = 0.008). No intubations without a box took more than 1 min, whereas 14 (58%) intubations with a box took over 1 min and 4 (17%) took over 2 min (including one failure). Without an aerosol box, all anaesthetists obtained first-pass success. With the early-generation and latest-generation boxes, 9 (75%) and 10 (83%) participants obtained first-pass success, respectively. One breach of personal protective equipment occurred using the early-generation box and seven breaches occurred using the latest-generation box. Aerosol boxes may increase intubation times and therefore expose patients to the risk of hypoxia. They may cause damage to conventional personal protective equipment and therefore place clinicians at risk of infection. Further research is required before these devices can be considered safe for clinical use. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/32397008/The_aerosol_box_for_intubation_in_coronavirus_disease_2019_patients:_an_in_situ_simulation_crossover_study_ L2 - https://doi.org/10.1111/anae.15115 DB - PRIME DP - Unbound Medicine ER -