The influence of a Perspex intubation box on time to intubation: a simulation-based randomised crossover study

Abstract

Background: Standard personal protective equipment guidelines are insufficient to prevent contamination of healthcare workers with droplet spread during the COVID-19 crisis. The added challenge of adequate aerosol protection has led to the development of an initial prototype intubation box. The primary objective was to determine the impact of an intubation box on the mean time to completion of intubation in a simulated airway. Secondary objectives included the best laryngoscopic view, the effect of intubator seniority and mode of laryngoscopy on intubation.

Methods: This was a randomised crossover study of the influence of an intubation box on mean time to completion of intubation of an airway management part-task trainer. Senior anaesthesiology staff were assigned to two groups and recordings of their attempts at intubation were analysed by two independent observers.

Results: The intubation box led to a significantly longer mean time to completion of intubation of 7.6 seconds (95% CI 3.1; 12.2; p = 0.001) with direct laryngoscopy and 9.2 seconds (95% CI 3.8; 14.7; p = 0.001) with videolaryngoscopy. It did not influence best glottic view.

Conclusion: We found that the use of an intubation box significantly prolonged the time to completion of intubation, but the clinical significance of the effect size is uncertain.