Influence of respiratory protective equipment on simulated advanced airway skills by specialist tracheal intubation teams during the COVID-19 pandemic

Schumacher, Jan; Carvalho, Clarissa; Greig, Paul; Ragbourne, Sophie; Ahmad, Imran

Background The COVID-19 pandemic has highlighted the importance of respiratory protective equipment for clinicians performing airway management. Aim To evaluate the impact of powered air-purifying respirators, full-face air-purifying respirators and filtering facepieces on specially trained anaesthesiologists performing difficult airway procedures. Methods All our COVID-19 intubation team members carried out various difficult intubation drills: unprotected, wearing a full-face respirator, a filtering facepiece or a powered respirator. Airway management times and wearer comfort were evaluated and analysed. Results Total mean (SD) intubation times did not show significant differences between the control, the powered, the full-face respirator and the filtering facepiece groups: Airtraq 6.1 (4.4) vs. 5.4 (3.1) vs. 6.1 (5.6) vs. 7.7 (7.6) s; videolaryngoscopy 11.4 (9.0) vs. 7.7 (4.3) vs. 9.8 (8.4) vs. 12.7 (9.8) s; fibreoptic intubation 16.6 (7.8) vs.13.8 (6.7) vs. 13.6 (8.1) vs. 16.9 (9.2) s; and standard endotracheal intubation by direct laryngoscopy 8.1 (3.5) vs. 6.5 (5.6) vs. 6.2 (4.2) vs. 8.0 (4.4) s, respectively. Use of the Airtraq achieved the shortest intubation times. Anaesthesiologists rated temperature and vision significantly better in the powered respirator group. Conclusions: Advanced airway management remains unaffected by the respiratory protective equipment used if performed by a specially trained, designated team. Glossary of Terms : AGPs: Aerosol-generating procedures. CBRN: Chemical, Biological and Radio-Nuclear. COVID-19: Coronavirus disease 2019. FFP: Filtering Facepiece. HCID: High consequence infectious diseases. HCW: Healthcare worker. MERIT: Mobile endotracheal rapid intubation team. PAPR: Powered air-purifying respirator. PPE: Personal protective equipment. RPE: Respiratory protective equipment. SARS: Severe acute respiratory syndrome. Conclusions We conclude that when advanced airway skills are performed by a designated, specially trained team, airway management times remain unaffected by the respiratory protective equipment used.