title: Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin.
abstract: BACKGROUND
  Following a chemical, biological, radiation and nuclear (CBRN) incident, prompt establishment of an advanced airway is required for patients with respiratory failure within the warm zone, while wearing personal protective equipment (PPE). Previous studies reported that intubation attempts were prolonged, and incidence of esophageal intubation was increased with conventional Macintosh laryngoscope (McL), while wearing CBRN-PPE. Pentax-AWS (AWS), a recently introduced portable video laryngoscope, was compared with the McL to test its utility for tracheal intubation while wearing CBRN-PPE.
  
  
  METHODS
  31 participants performed unsuited and suited intubations on an advanced life support simulator. The sequence of intubating devices and PPE wearing were randomised. Time to complete tracheal intubation (primary end point), time to see the vocal cords, overall success rate, percentage of glottic opening, dental compression and ease of intubation were measured.
  
  
  RESULTS
  Suited intubations required significantly longer time to complete intubation than unsuited intubations, in both McL and AWS (22.2 vs 26.4 s, 14.2 vs 18.2 s, respectively). However, suited AWS intubations required shorter time to complete tracheal intubation than unsuited McL intubations (18.2 vs 22.2 s). In secondary outcomes, moreover, suited intubations using the AWS compared favourably with unsuited intubations using the McL.
  
  
  CONCLUSIONS
  Although the CBRN-PPE adversely affected time required to complete tracheal intubation with the AWS, suited intubations using the AWS were even superior to unsuited intubations using the McL. The AWS should be a promising device to perform tracheal intubation while wearing the CBRN-PPE.
authors.affiliation: Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Shin
authors.forename: Pil Cho
authors.initials: PC
authors.lastname: Choi
authors.forename: Ji Ung
authors.initials: JU
authors.lastname: Na
authors.forename: Jun Hwi
authors.initials: JH
authors.lastname: Cho
authors.forename: Sang Kuk
authors.initials: SK
authors.lastname: Han
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005260:Female; D015386:Hazardous Substances / Q000009:adverse effects; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes / Q000706:statistics & numerical data*; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008348:Manikins; D016544:Patient Simulation; D011481:Protective Clothing / Q000009:adverse effects* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D013997:Time Factors
chemical_list: D015386:Hazardous Substances
keywords: CBRN; airway; intubation; manikin; resuscitation; toxicology; video laryngoscopy