Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: A manikin study

Six different supraglottic airway devices: Combitube (TM), laryngeal mask airway, intubating laryngeal mask airway (Fastrach (TM)), i-gel (TM), Laryngeal Tube (TM) and Pro-Seal (TM) laryngeal mask airway were assessed by 58 paramedic students for speed and ease of insertion in a manikin, whilst wearing either chemical, biological, radiation, nuclear-personal protective equipment (CBRN-PPE) or a standard uniform. All devices took significantly longer to insert when wearing CBRN-PPE compared with standard uniform (p < 0.001). In standard uniform, insertion time was shorter than 45 s in 90% of attempts for all devices except the Combitube, for which 90% of attempts were completed by 53 s. Whilst wearing CBRN-PPE the i-gel was the fastest device to insert with a mean (SD (95% CI)) insertion time of 19 (8 (17-21)) s, p < 0.001, with the Combitube the slowest with mean (65 (23 (59-71)) s. Wearing of CBRN-PPE has a negative impact on supraglottic airway insertion time.