title: Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices.
abstract: BACKGROUND
  Early respiratory support and airway (AW) control with endotracheal intubation (ETI) are crucial in mass toxicology events and must be performed while wearing chemical personal protective equipment (C-PPE).
  
  
  OBJECTIVE
  The aim of this study is to evaluate the efficiency of AW control by using second-generation supraglottic AW devices (SADs) as compared with ETI and first-generation SAD while wearing C-PPE.
  
  
  METHODS
  This is a randomized crossover trial involving 117 medical practitioners. Four AW management devices were examined: endotracheal tube, the first-generation SAD, laryngeal mask AW unique and 2 second-generation SAD, the laryngeal tube suction disposable, and supreme laryngeal mask AW (SLMA). Primary end point measured were success or failure, number of attempts, and time needed to achieve successful device insertion. Secondary end point was a subjective appraisal of the AW devices by study population.
  
  
  RESULTS
  More attempts were required to achieve AW control with endotracheal tube, with and without C-PPE (P<.001). Time to achieve AW control with ETI was, on average, 88% longer than required with other devices and improved with practice. The mean times to achieve an AW were longer when operators were equipped with C-PPE as compared with standard clothing. Subjectively, difficulty levels were significantly higher for ETI than for all other devices (P<.0001).
  
  
  CONCLUSIONS
  When compared with ETI, the use of SADs significantly shortened the time for AW control while wearing C-PPE. Second-generation SAD were superior to laryngeal mask AW unique. These finding suggest that SADs may be used in a mass toxicology event as a bridge, until definite AW control is achieved.
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Nimrod
authors.initials: N
authors.lastname: Ophir
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Ramaty
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Rajuan-Galor
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel. Electronic address: rosmanyossi@gmail.com.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Rosman
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Lavon
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Shrot
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
authors.forename: Arthur
authors.initials: A
authors.lastname: Shiyovich
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Huerta-Hartal
authors.affiliation: Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Kassirer
authors.affiliation: Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vaida
authors.affiliation: Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
authors.forename: Luis
authors.initials: L
authors.lastname: Gaitini
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D002618:Chemical Warfare; D002983:Clinical Competence; D018592:Cross-Over Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D017214:Laryngeal Masks; D054527:Mass Casualty Incidents; D010820:Physicians; D011481:Protective Clothing; D013997:Time Factors; D055815:Young Adult