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Qualitative interview study of clinicians’ opinions of which intubation aids to use following a CBRN incident

06 April 2012
Features
02 April 2012
Volume 4 · Issue 4

Abstract

Aim: to ascertain what intubation aids clinicians believed should be consideredfor further evaluation for use while wearing CBRN-PPE

Introduction: Intubation remains a key treatment option for the managementof casualties with respiratory failure following a chemical biological radiationnuclear (CBRN) incident. However, CBRN personnel protective equipment (CBRN-PPE) adversely affects intubation performance. To date, only the IntubatingLaryngeal Mask airway has been evaluated as an intubation aid for use whilewearing CBRN-PPE within a randomized control study.

Methods: This is a qualitative, interview based study involving 25 clinicians fromvarious backgrounds. All interviewees had previously been involved in a numberof manikin based CBRN-PPE research studies involving airway managementincluding intubation.

Results: Five different intubation aids were identified by the interviewees, including the gum elastic bougie, Airtraq™, stylet, Intubating Laryngeal MaskAirway and the McCoy laryngoscope as well as non intubation aids such aspractising intubation techniques while wearing CBRN-PPE, training with regardsto optimal techniques for intubation/airway management while wearing CBRN-PPE, correct/optimal patient position as well as the availability of a skilledassistant.

Conclusion: This interviewed opinion based study involving UK clinicianswith experience of performing intubation and other related resuscitationtechniques while wearing CBRN-PPE has identified a number of intubation aidsthat clinicians believe may assist with intubation performance by potentiallyimproving speed and/or intubation success within the CBRN environment.However, the loss of fine motor movement and tactile sensation has beenidentified as a possible limitation of the devices and therefore these intubationaids warrant further evaluation. The role of training in skill performance andsimulation based practise, while wearing CBRN-PPE, also requires furtherinvestigation.

Respiratory failure following a chemical, biological, radiation or nuclear (CBRN)incident is primarily due to the direct affectsof the agents used (Baker, 1996), but it may also be due to hypoxia from associated non-cardiogenicpulmonary oedema, or airway obstruction secondaryto reduced conscious levels (Muskat, 2008). CBRNinduced respiratory failure is amenable to prompttreatment resulting in successful resuscitation ofcritically ill patients (Okumura et al, 1996; Stacey etal, 2004) but delays in treatment can be devastating(Schiermeier, 2002). Although treatment mayfacilitate successful resuscitation the performanceof emergency skills are complicated by the need ofthe responding rescue personnel to wear bulky andcumbersome CBRN-Personal Protective Equipment(CBRN-PPE) which is known to adversely affectfne motor skills (Castle et al, 2009). However, failure to wear CBRN-PPE can result in health careprofessionals becoming casualties (Nozaki et al,1995; Nakajima et al, 1997; Geller et al, 2000; Stacey et al, 2004).

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Intubation
CBRN
CBRN-PPE
Difficult airway