Impact of Personal Protective Equipment on the First-Pass Success of Endotracheal Intubation in the ED: A Propensity-Score-Matching Analysis

Abstract

Various types and levels of personal protective equipment (PPE) are currently available to protect health-care workers against infectious diseases. However, wearing cumbersome PPE may negatively affect their performance in life-saving procedures. This study aimed to evaluate the impact of wearing extensive PPE, including a powered air-purifying respirator with a loose-fitting hood or an N95 filtering facepiece respirator, on the first-pass success (FPS) rate of endotracheal intubation (ETI) in the emergency department (ED). This study was a single-center, observational before-and-after study of 934 adult (≥18 years old) patients who underwent ETI in the academic ED. The study period was divided into a control period (from 20 January 2019, to 30 September 2019, and from 20 January 2018, to 30 September 2018) and an intervention period (from 20 January 2020, to 30 September 2020). Extensive PPE was not donned during the control period (control group, n = 687) but was donned during the intervention period (PPE group, n = 247). The primary outcome was the FPS rate. We used propensity score matching between the PPE and control groups to reduce potential confounding. Propensity score matching identified 247 cases in the PPE group and 492 cases in the control group. In the matched cohort, no significant difference was found in the FPS rate between the PPE and control groups (83.8% (n = 207) vs. 81.9% (n = 403); p = 0.522). In multivariable analysis, wearing PPE was not associated with the FPS rate (adjusted odds ratio, 0.90; 95% confidence interval, 0.57–1.40; p = 0.629) after adjusting for the level of the intubator (junior resident, senior resident, or emergency medicine (EM) specialist). In conclusion, the FPS rate is not significantly affected by wearing extensive PPE in the ED.

Prolonged Use of Protective Masks Induced Facial Skin Injury in Primary Healthcare Workers during COVID-19 Pandemic: A Systematic Review

“…However, 3 studies did not satisfy the inclusion criteria, 14 of which were still included in the qualitative analysis (systematic study). [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Figure 1 summarizes the literature search process as indicated by the PRISMA Guideline. From all included articles, 10,430 respondents participated in several observational studies.…”

Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment

“…On 19 January 2020, South Korea reported its first confirmed COVID-19 case [ 13 ]. Several infection control measures were implemented in the ED in response to this novel infectious disease [ 3 , 14 ]. Enhanced PPE, a full bodysuit, or at least a waterproof gown, an apron, double gloves, boots, and powered air-purifying respirators (PAPRs) were mandated for all EMP engaging in the ETI procedure for undifferentiated patients with COVID-19-related symptoms (see Appendix A , Figure A1 ) [ 14 ].…”

“…We use two different PAPRs: A 3M Jupiter Powered Air Turbo with a breathing tube (BT-20 L) and a loose-fitting hood (S-433 L-5) (3M, St. Paul, MN, USA), and an AIR WING III PAPR system with a hood kit (OTOS, Seoul, Korea). General PPE, including a face shield or goggles, was used instead of PAPRs in patients identified as having a low likelihood of COVID-19 infection [ 14 ].…”

The Effect of the COVID-19 Pandemic on the Mental Health of Healthcare Providers (HCPs) for Patients with Confirmed or Suspected Cases of COVID-19

“…Therefore, some responsibilities were stressful because healthcare providers had to protect themselves. Precautionary measures such as wearing personal protective equipment had to be embraced in healthcare facilities (Khanal et al, 2020, Choi et al, 2021.…”