Video Laryngoscope Intubation With an Aerosol Barrier Device: A Randomized Sequential Crossover Pilot Study

Area of Science:

• Medical Simulation
• Airway Management
• Infectious Disease Control

Background:

• Endotracheal intubation is a critical procedure in emergency medicine and critical care.
• Aerosol-generating procedures, like intubation, pose infection risks, necessitating protective measures.
• The Splashguard-CG is an aerosol barrier device designed to mitigate these risks during intubation.

Purpose of the Study:

• To evaluate the impact of the Splashguard-CG aerosol barrier on endotracheal intubation time using different laryngoscope types.
• To assess the effect of the device on both experienced and less-experienced physicians in a simulated setting.

Main Methods:

• A pilot randomized sequential crossover simulation study was conducted with 30 physicians at a Japanese academic hospital.
• Participants performed endotracheal intubation on a manikin simulator using Macintosh, Airway Scope, and McGRATH MAC laryngoscopes, with and without the Splashguard-CG.
• Intubation time was the primary outcome, supplemented by subjective difficulty assessment using a Visual Analog Scale.

Main Results:

• No significant increase in intubation time was observed when using the Splashguard-CG with the Airway Scope or McGRATH MAC video laryngoscopes.
• A significant increase in intubation time was noted with the Macintosh laryngoscope when used with the Splashguard-CG (median difference 4.3 seconds, p < 0.001).
• Subjective difficulty of endotracheal intubation increased significantly across all three laryngoscope types when the Splashguard-CG was used.

Conclusions:

• The Splashguard-CG aerosol barrier device does not significantly prolong endotracheal intubation time with video laryngoscopes in a simulated environment.
• While not impacting intubation duration for video laryngoscopes, the device increased perceived difficulty.
• The findings suggest that video laryngoscopes combined with aerosol barriers may be a viable airway management strategy for infections like COVID-19, with careful consideration of user experience.