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A prospective randomised simulation trial comparing our novel AIR-BOX to standard airway equipment storage modalities
  1. Wojciech Piechowski,
  2. Timothy C Clapper,
  3. Joel C Park,
  4. Kevin Ching,
  5. Jonathan St. George
  1. Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
  1. Correspondence to Wojciech Piechowski, Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, 535 East 68th Street; M-130, New York, NY 10065, USA; wop9003{at}med.cornell.edu

Abstract

Background There is little evidence guiding equipment handling during emergency endotracheal intubations (EEI). Available evidence and current practice are either outdated, anecdotal or focused on difficult—not emergency—intubation. In this study, we describe and evaluate our equipment handling unit: the AIR-BOX.

Methods This is a proof-of-concept, prospective, randomised simulation trial. A convenience sample of 50 airway course participants voluntarily underwent randomisation: 21 to the AIR-BOX group, 14 to the intubation box group, and 15 to the crash cart group. The volunteers were asked to intubate a manikin using the equipment from the storage unit of their randomisation. Outcome measures included time-to-readiness, time-to-intubation, first-pass success, and subjective operator experience.

Results The mean time-to-readiness was 67.2 s with the AIR-BOX, 84.6 s with the intubation box, and 115 s with the crash cart. The mean time-to-intubation was 105 s with the AIR-BOX, 127 s with the intubation box and 167 s with the crash cart. A statistically significant difference was achieved between the AIR-BOX and the crash cart. No statistically significant difference was found between the three groups with regard to first-pass success or the time between intubation readiness and intubation.

Conclusions This study supports the AIR-BOX as a viable tool that can improve and simplify access to emergency intubating equipment. It also opens doors for multiple future innovations that can positively impact equipment handling practices. Future studies can focus on assessing whether applying the AIR-BOX will yield a clinically significant impact on patient outcomes.

  • Airway
  • Anaesthesia
  • Cognitive Load
  • Emergency Medicine
  • Equipment

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Footnotes

  • Acknowledgement We would like to thank our volunteers, Michelle Xiao Dan Guo, Allison Malet, and Kimi San Miguel, as well as simulation center specialists, Joanna Flores and Ming Cooke, for their tireless work and for helping us make this project possible. Special appreciation also goes to Dr. Kaushal Shah, our vice-chair of education, for his ongoing mentorship, insight, and support.

  • Author note Author JCP has ended the above affiliation after the completion of this study, including data acquisition, data analysis, as well as drafting and editing the manuscript. JCP declares that he is an employee and shareholder of BeiGene, Ltd.

  • Contributors WP contributed to: study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. TCC contributed to: study concept and design, acquisition of the data, critical revision of the manuscript for important intellectual content. JCP contributed to: analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical expertise. KC contributed to: study concept and design, critical revision of the manuscript for important intellectual content. JSG contributed to: study concept and design, acquisition of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Prior presentations None. We submitted our work to our institution’s internal Quality & Patient Safety poster session. However, the session was cancelled due to COVID-19.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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