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Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin
  1. Dong Hyuk Shin1,2,
  2. Pil Cho Choi1,
  3. Ji Ung Na1,
  4. Jun Hwi Cho3,
  5. Sang Kuk Han1,2
  1. 1Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. 2Department of Emergency Medicine, Graduate School, College of Medicine, Kangwon National University, Chuncheon, Korea
  3. 3Department of Emergency Medicine, Institute of Medical Sciences, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, Korea
  1. Correspondence to Sang Kuk Han, Department of Emergency Medicine, Kangbuk Samsung Hospital, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Korea; sk01.han{at}


Introduction Following a chemical, biological, radiation and nuclear (CBRN) incident, prompt establishment of an advanced airway is required for patients with respiratory failure within the warm zone, while wearing personal protective equipment (PPE). Previous studies reported that intubation attempts were prolonged, and incidence of esophageal intubation was increased with conventional Macintosh laryngoscope (McL), while wearing CBRN-PPE. Pentax-AWS (AWS), a recently introduced portable video laryngoscope, was compared with the McL to test its utility for tracheal intubation while wearing CBRN-PPE.

Methods 31 participants performed unsuited and suited intubations on an advanced life support simulator. The sequence of intubating devices and PPE wearing were randomised. Time to complete tracheal intubation (primary end point), time to see the vocal cords, overall success rate, percentage of glottic opening, dental compression and ease of intubation were measured.

Results Suited intubations required significantly longer time to complete intubation than unsuited intubations, in both McL and AWS (22.2 vs 26.4 s, 14.2 vs 18.2 s, respectively). However, suited AWS intubations required shorter time to complete tracheal intubation than unsuited McL intubations (18.2 vs 22.2 s). In secondary outcomes, moreover, suited intubations using the AWS compared favourably with unsuited intubations using the McL.

Conclusions Although the CBRN-PPE adversely affected time required to complete tracheal intubation with the AWS, suited intubations using the AWS were even superior to unsuited intubations using the McL. The AWS should be a promising device to perform tracheal intubation while wearing the CBRN-PPE.

  • CBRN
  • intubation
  • manikin
  • video laryngoscopy
  • airway
  • resuscitation
  • toxicology

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  • Funding This article was not financially supported by any company or organisation.

  • Competing interests None.

  • Patient consent This study was a randomised crossover trial on a manikin, and participants were less experienced medical doctors. Consent form approved by the Institutional Review Board of Kangbuk Samsung Hospital has been signed by participants.

  • Ethics approval Ethics approval was provided by Institutional Review Board of Kangbuk Samsung Hospital.

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