Efficiency, limitations, and familiarization of a novel negative pressure aerosol box for intubation: a simulation-based randomized crossover study

Abstract

Objective This study aimed to introduce a novel negative pressure aerosol box (Carrycure Isolator) and to test its efficiency and limitations, with the hope of suggesting improvements and further directions. Methods A novel aerosol box (Carrycure Isolator) was invented. A single-center, randomized, crossover simulation study of 28 emergency medicine physicians was designed. Three trials of each participant using an intubation manikin were conducted, including intubation without the aerosol box (trial A), intubation with the aerosol box (trial B), and intubation with the aerosol box after familiarization (trial C). The primary endpoint was the time to intubation. The secondary endpoints were first-attempt success, number of attempts, percentage of glottic opening score, and Cormack-Lehane view. Collected data were statistically analyzed for their significance. Results The median times to intubation of trials A, B, and C were 30.5 (interquartile range [IQR], 28.0–40.0 seconds), 59.0 (IQR, 50.0–75.5 seconds), and 34.0 seconds (IQR, 30.5–47.0 seconds), respectively. Post hoc analysis showed that the time to intubation in trial B was significantly longer than that in trial A (P<0.05), while that the time to intubation in trial C was significantly shorter than that in trial B (P<0.05). Results concerning secondary endpoints showed similar patterns. Participants reported performing intubation with Carrycure Isolator to be relatively difficult, necessitating significant arm movement and view restrictions while increasing their time to intubation. Conclusion Physicians took a longer time to intubate a manikin using the Carrycure Isolator, a novel negative pressure aerosol box. However, the time was improved after a period of familiarization.

Keywords

• patient isolators
• efficiency
• simulation training
• crossover studies
• intratracheal intubation