Rise and fall of the aerosol box; and what we must learn from the adoption of untested equipment

On strife, natural selection and success in airway management during the COVID-19 pandemic: Shifting from best guess to best practice

“…To further enrich the comparisons, each scenario was repeated using both direct and video laryngoscopy. As other studies have found [ [9] , [10] , [11] , [12] , [13] ], [ [9] , [10] , [11] , [12] , [13] ] they observed longer intubation times and increased difficulty with APE, as well as an instance of breech in PPE.…”

“…Should we then conclude that APE use is advantageous, or conversely, that we should quit monkeying about with further APE species? Expert opinion and increasing evidence leans strongly towards the latter: the increased difficulty, time taken for intubation, ongoing theme of breeches in PPE, and most significantly the lack of evidence for effectiveness in preventing transmission of infection suggest that barrier devices were an inventive concept which have proven inadequate in practice [ [11] , [12] , [13] ].…”

Sheet Barrier and Intubating Stylet

“…Meanwhile, some airway management experts expressed their serious concerns on such a MacGyverism-style improvised medical device (e.g., the "aerosol box") and argued about the untested effectiveness and safety issues of this EUA device [23][24][25][26][27]. The main Meanwhile, some airway management experts expressed their serious concerns on such a MacGyverism-style improvised medical device (e.g., the "aerosol box") and argued about the untested effectiveness and safety issues of this EUA device [23][24][25][26][27]. The main Meanwhile, some airway management experts expressed their serious concerns on such a MacGyverism-style improvised medical device (e.g., the "aerosol box") and argued about the untested effectiveness and safety issues of this EUA device [23][24][25][26][27].…”

“…The main Meanwhile, some airway management experts expressed their serious concerns on such a MacGyverism-style improvised medical device (e.g., the "aerosol box") and argued about the untested effectiveness and safety issues of this EUA device [23][24][25][26][27]. The main Meanwhile, some airway management experts expressed their serious concerns on such a MacGyverism-style improvised medical device (e.g., the "aerosol box") and argued about the untested effectiveness and safety issues of this EUA device [23][24][25][26][27]. The main concerns raised against such physical barrier enclosure include the following: (1) restriction of hand movement of the intubator and assistants; (2) heavy and bulky plexiglass is difficult to carry and position or reposition in emergency situations; (3) limited for certain body habitus and positions; (4) confined space for airway maneuvering; (5) ergonomically difficult to manipulate airway equipment; (6) introducing other new risks of cross-contamination during the use, disinfection, and disposal processes; (7) increases the cognitive load of the staff and the risk of subsequent contamination; and (8) breaches in PPE due to a tear cut by the box edge.…”