Abstract
IntroductionThe use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department.MethodsThis was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty.ResultsForty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6–68 seconds] vs mean 10 seconds [range 5–40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained.ConclusionUse of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.
Highlights
The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic
There were no significant differences in the number of attempts or quality of view obtained
Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated emergency department (ED) patients. [West J Emerg Med. 2020;21(6)78-82.]
Summary
The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department. Effect of an Aerosol Box on Intubation in Simulated ED Airways barriers to prevent droplet spread during endotracheal intubation.[4,5,6] Decreased spread of simulated droplet particles has been demonstrated with the use of such a box during a cough simulation.[4] aerosol boxes have received extensive attention on social media and there is evidence of worldwide distribution of such devices,[7] some have cautioned against widespread implementation without further research into potential negative effects.[8].
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