Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Emerg Med J. 2021 Feb;38(2):111-117. doi: 10.1136/emermed-2020-210514. Epub 2020 Nov 20.
Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE.
This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants' feedback.
Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box.
An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator's mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE.
由于对 SARS-CoV-2 高传播风险的担忧，在为 COVID-19 患者进行气道插管时，创新并使用了气腔盒以保护医护人员。但其作为屏障保护的效果，除了使用标准的个人防护设备 (PPE) 之外，尚不完全清楚。我们进行了一项模拟研究，以调查在插管过程中使用气腔盒与医护人员在脱下 PPE 前后的污染之间的关系。
这是一项于 2020 年 4 月 9 日至 5 月 5 日在马来西亚大学医学中心急诊室进行的随机交叉研究。住院医师进行了视频喉镜辅助插管，在气腔盒有或无气腔盒的情况下以随机顺序进行。通过雾化 Glo Germ 模拟污染。主要结局是在未使用和使用气腔盒的情况下，在脱下 PPE 之前和之后，插管者和助手的身体正面和背面污染的区域数量。次要结局是插管时间、Cormack-Lehane 评分、插管尝试次数和参与者的反馈。
36 名受训者完成了研究干预。在不使用气腔盒的情况下，PPE 前的身体正面和背面污染区域数量明显更高（所有 p 值均<0.001）。然而，在使用和气腔盒之间，在脱下 PPE 之后，污染的数量没有显著差异，中位数为零。使用气腔盒时，插管时间更长（42.5s 比 35.5s，p<0.001）。使用和气腔盒时，Cormack-Lehane 评分相似。在使用和气腔盒时，首次插管成功率分别为 94.4%和 100%。更多的参与者报告说，在使用气腔盒进行插管时，移动性和可视性降低。
气腔盒可能显著降低暴露于污染的风险，但会增加插管时间，并降低操作者的移动性和可视性。此外，使用和气腔盒之间污染程度的差异可以通过正确脱下 PPE 来抵消。
