title: CobraPLA Insertion by anesthetists and non-anesthetists wearing unconventional protective gear: a prospective study in humans.
abstract: BACKGROUND
  The threat of a mass casualty unconventional attack has challenged the medical community to devise means for providing rapid and reliable emergent airway control under chaotic conditions by inexperienced medical personnel dressed in self protective gear. Since endotracheal intubation may not be feasible under those conditions, other extraglottic devices should be considered. We assessed the performance of anesthesia and non-anesthesia residents in inserting the CobraPLA, a supraglottic airway device, on consecutive anesthetized patients, to assess its potential use under simulated conditions.
  
  
  METHODS
  Anesthesia and non-anesthesia residents wearing either surgical scrubs or complete anti-chemical gear inserted the CobraPLA in anesthetized patients. If post-trial positive pressure ventilation via the CobraPLA was unsuccessful, an LMA or endotracheal tube was inserted in its stead.
  
  
  RESULTS
  It took anesthesia residents 57+/-23 sec and 43+/-13 sec (P<0.05) to place the CobraPLA while wearing anti-chemical gear and surgical scrubs, respectively. Non-anesthesia residents wearing anti-chemical gear performed worse than anesthetists in their first insertion (73+/-9 sec, P<0.05), but after the brief training period they performed as well as their colleagues anesthetists (58+/-10 sec, P=NS). Post-trial, twenty-one CobraPLA (42%) leaked, preventing adequate positive-pressure ventilation: 13 devices (26% of the total) required replacements.
  
  
  CONCLUSIONS
  Anti-chemical protective gear slowed the insertion of the CobraPLA by anesthetists, and more so by other residents inexperienced in airway management. In 26% of the cases CobraPLA was inadequate for positive pressure ventilation.
authors.affiliation: Anesthesia and Critical Care Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ben-Abraham
authors.forename: Ron
authors.initials: R
authors.lastname: Flaishon
authors.forename: Alexander
authors.initials: A
authors.lastname: Sotman
authors.forename: Perla
authors.initials: P
authors.lastname: Ekstein
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.forename: Daniel
authors.initials: D
authors.lastname: Ogorek
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000328:Adult; D000776:Anesthesiology; D003710:Demography; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male; D010820:Physicians; D011446:Prospective Studies; D011481:Protective Clothing; D013997:Time Factors