Antichemical protective gear prolongs time to successful airway management: a randomized, crossover study in humans.
BACKGROUND
Airway management is the first step in resuscitation. The extraordinary conditions in mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The authors evaluated whether wearing surgical attire or antichemical protective gear made any difference in anesthetists' success of airway control with either an endotracheal tube or a laryngeal mask airway.


METHODS
Fifteen anesthetists with 2-5 yr of residency and wearing either full antichemical protective gear or surgical attire intubated or inserted laryngeal masks in 60 anesthetized patients. The study was performed in a prospective, randomized, crossover manner. The duration of intubation/insertion was measured from the time the device was grasped to the time a normal capnography recording was obtained.


RESULTS
Endotracheal tubes were introduced significantly (P < 0.01) faster when the anesthetist wore surgical attire (31 +/- 7 vs. 54 +/- 24 s for protective gear), but the mean times necessary to successfully insert laryngeal masks were similar (44 +/- 20 s for surgical attire vs. 39 +/- 11 s for protective gear). Neither performance failure nor incidences of hypoxemia were recorded.


CONCLUSIONS
This first report in humans shows to what extent anesthetists' wearing of antichemical protective gear slows the time to intubate but not to insert a laryngeal mask airway compared with wearing surgical attire. Laryngeal mask airway insertion is faster than tracheal intubation when wearing protective gear, indicating its advantage for airway management when anesthetists wear antichemical protective gear. If chances for rapid and successful tracheal intubation under such chaotic conditions are poor, laryngeal mask airway insertion is a viable choice for airway management until a proper secured airway is obtainable.
Flaishon
Ron
R
Department of Anesthesiology and Critical Care Medicine, Directorate, and Outpatient Surgery and Post-Anesthesia Care Units, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sotman
Alexander
A
Ben-Abraham
Ron
R
Rudick
Valery
V
Varssano
David
D
Weinbroum
Avi A
AA
D000328:Adult; D000368:Aged; D000776:Anesthesiology; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007557:Israel; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D011481:Protective Clothing; D013997:Time Factors; D014857:Warfare