title: Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study.
abstract: OBJECTIVE
  This study aimed to compare visualisation of the vocal cords and performance of intubation by anaesthetists using four different laryngoscopes while wearing full chemical protective equipment.
  
  
  METHODS
  Medical simulation center of a university hospital, department of anaesthesiology.
  
  
  METHODS
  42 anaesthetists (15 females and 27 males) completed the trial. The participants were grouped according to their professional education as anaesthesiology residents with experience of <2 years or <5 years, or as anaesthesiology specialists with experience of >5 years.
  
  
  METHODS
  In a manikin scenario, participants performed endotracheal intubations with four different direct and indirect laryngoscopes (Macintosh (MAC), Airtraq (ATQ), Glidescope (GLS) and AP Advance (APA)), while wearing chemical protective gear, including a body suit, rubber gloves, a fire helmet and breathing apparatus.
  
  
  METHODS
  With respect to the manikin, setting time to complete 'endotracheal intubation' was defined as primary end point. Glottis visualisation (according to the Cormack-Lehane score (CLS) and impairments caused by the protective equipment, were defined as secondary outcome measures.
  
  
  RESULTS
  The times to tracheal intubation were calculated using the MAC (31.4 s; 95% CI 26.6 to 36.8), ATQ (37.1 s; 95% CI 28.3 to 45.9), GLS (35.4 s; 95% CI 28.7 to 42.1) and APA (23.6 s; 95% CI 19.1 to 28.1), respectively. Intubation with the APA was significantly faster than with all the other devices examined among the total study population (p<0.05). A significant improvement in visualisation of the vocal cords was reported for the APA compared with the GLS.
  
  
  CONCLUSIONS
  Despite the restrictions caused by the equipment, the anaesthetists intubated the manikin successfully within adequate time. The APA outperformed the other devices in the time to intubation, and it has been evaluated as an easily manageable device for anaesthetists with varying degrees of experience (low to high), providing good visualisation in scenarios that require the use of chemical protective equipment.
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schröder
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Anesthesiology and Intensive Care, St Elisabeth Hospital, Gütersloh, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Zoremba
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Department of Internal Medicine, Aachen District Medical Center, Würselen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Deusser
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Stoppe
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Coburn
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Rieg
authors.affiliation: Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schälte
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence / Q000592:standards*; D004867:Equipment Design; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes / Q000145:classification*; D008297:Male; D008348:Manikins; D010865:Pilot Projects; D011481:Protective Clothing; D013997:Time Factors
keywords: ACCIDENT & EMERGENCY MEDICINE; CBRN; Chemical Protective Equipment; Manikin Study; TRAUMA MANAGEMENT; Videolaryngoscopy