title: Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study.
abstract: BACKGROUND
  Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.
  
  
  METHODS
  Post-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.
  
  
  RESULTS
  Twenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.
  
  
  CONCLUSIONS
  The time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Aberle
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Sandefur
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Kharmene L
authors.initials: KL
authors.lastname: Sunga
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Ronna L
authors.initials: RL
authors.lastname: Campbell
authors.affiliation: 2Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Henrique
authors.initials: H
authors.lastname: Alecastro Puls
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Laudon
authors.affiliation: 1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Sztajnkrycer
mesh_terms: D018592:Cross-Over Studies; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008348:Manikins; D011481:Protective Clothing; D011795:Surveys and Questionnaires; D013997:Time Factors; D014741:Video Recording
keywords: BVM bag valve mask; Biological; CBRNE Chemical; DL direct laryngoscopy; ED emergency department; EMS Emergency Medical Services; ETI endotracheal intubation; Explosive; HazMat hazardous materials; LMA laryngeal mask airway; Nuclear; PAPR powered air-purifying respirator; PGY post-graduate year; PPE personal protective equipment; Radiological; VL video laryngoscopy; direct laryngoscopy; hazardous materials; personal protective equipment; video laryngoscopy