Effect of using barrier devices on intubation times and performance—a randomized, prospective, crossover manikin study

Abstract

BackgroundThe impact of barrier devices on endotracheal intubation times is unknown.ObjectiveWe sought to compare the effects using conventional personal protective equipment, an aerosol box, and a transparent plastic drape on intubation times by experienced emergency physicians on a manikin in both the sniffing and ramped positions in a randomized, prospective cross-over study design.MethodsA total of 13 experienced emergency physicians performed endotracheal intubations on a manikin in both the sniffing and ramped positions using conventional personal protective equipment (PPE), an aerosol box, and a transparent plastic drape. The primary outcome was intubation time; secondary outcomes included first-pass success rates and ratings of difficulty in accessing the device, inserting the endotracheal tube into the glottis, maneuvering the laryngoscope, and clear vision of the manikin’s face.ResultsThe use of an aerosol box or transparent plastic drape increased intubation times in both the sniffing and ramped positions. First-pass success rates did not differ between the groups. Perceptions of difficulty accessing the device, inserting the endotracheal tube into the glottis, maneuvering the laryngoscope, and obtaining a clear view of the manikin’s face to the model were higher when using the aerosol box and transparent plastic drape compared to intubation with only PPE.ConclusionAn aerosol box and transparent plastic drape may increase intubation times during endotracheal intubation of coronavirus disease 2019 (COVID-19) patients in both the sniffing and ramped positions. Further research should investigate the utility of these devices during endotracheal intubation.Trial registration number and date: NCT04412226; 31 May 2020.