You are here

Article Text

Article menu

Download PDFPDF

Images in clinical practice
Military gas mask to protect surgeons when performing tracheotomies on patients with COVID-19
Free
  1. Jean-Baptiste Caruhel1,
  2. N Sigaux2,
  3. A Crambert1,
  4. N Donat3,
  5. G Boddaert4,
  6. P Haen5 and
  7. C Hoffmann3
  1. 1 Maxillo-facial, Head and Neck Surgery Department, Hopital d'Instruction des Armees Percy, Clamart, France
  2. 2 Maxillo-Facial Surgery Department, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
  3. 3 Intensive Care Unit and Burn Center, Hopital d'Instruction des Armees Percy, Clamart, Île-de-France, France
  4. 4 Department of Thoracic and Vascular Surgery, Hopital d'Instruction des Armees Percy, Clamart, Île-de-France, France
  5. 5 Maxillo-Facial Surgery Department, Hopital d'Instruction des Armees Laveran, Marseille, Provence-Alpes-Côte d'Azur, France
  1. Correspondence to Dr Jean-Baptiste Caruhel, Maxillo-facial, Head and Neck Surgery Department, Hopital d'Instruction des Armees Percy, Clamart 92140, France; docteur.caruhel{at}gmail.com

http://dx.doi.org/10.1136/bmjmilitary-2020-001547

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Key messages

    • Military gas masks allow safe performance of tracheotomies when faced with a high risk of virus transmission.

    • Gas masks can be useful when FFP3 masks are lacking or when operating in restricted military situations.

    • Gas masks are reusable after decontamination.

    • Awareness of this device and the ability to perform surgery with this procedure could be crucial during pandemics.

    Tracheotomy is frequently indicated for patients with COVID-19 suffering from severe acute respiratory syndrome (SARS). The French Army Biomedical Research Centre provided our hospital with military masks equipped with P3 filter cartridges and an integrated ventilation unit that would allow safe performance of this procedure when faced with a high risk of virus transmission (Figure 1). FFP2 or FFP3 masks can provide proper protection, as these masks have an efficiency of 95%–99% when tested with 0.30 µm particles. However, their efficacy for SARS-CoV-2 protection has not been explored, and the virus has a smaller calibre (0.1–0.15 µm).1 An additional concern is the potential risk of progressive degradation and increasing porosity, which could explain the lower efficiency of FFP2 or FFP3 masks compared with powered air-purifying respirators.2 By contrast, the gas mask, originally designed to protect soldiers against biological and chemical attacks, provides full protection. The filter in the device is comparable with an FFP3 filter and can be fully effective for hours without performance degradation. The filter and the powered air-purifying respirator are also positioned at the back of the surgeon, away from the patient’s airways and from virus projection during the trachea incision. Gas masks can be useful when FFP3 masks are lacking or when operating in restricted military situations. Gas masks are also reusable after decontamination.

    Figure 1
    Figure 1

    Surgeon equipped with French Army mask with P3 filter cartridges and integrated ventilation unit.

    Despite the use of an unaccustomed procedure, we performed 20 tracheotomies without any complications (Figure 2). Awareness of this device and the ability to perform surgery with this procedure could be crucial during the COVID-19 pandemic and might be applied in the fight against other and more aggressive viruses, such as Ebola.

    Figure 2
    Figure 2

    Surgical tracheotomy performed with military gas mask.

    References

    1. ↵
      2. Lu R ,
      3. Zhao X ,
      4. Li J , et al
      . Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–74.doi:10.1016/S0140-6736(20)30251-8 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32007145
      OpenUrlCrossRefPubMed
    2. ↵
      2. Christian MD ,
      3. Loutfy M ,
      4. McDonald LC , et al
      . Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004;10:287–93.doi:10.3201/eid1002.030700 pmid:http://www.ncbi.nlm.nih.gov/pubmed/15030699
      OpenUrlPubMedWeb of Science

    Footnotes

    • Contributors J-BC: writing, literature search, data analysis. NS: critical revision. AC: literature search, responsible for simulation. ND: device manager, data analysis. GB: surgical team manager. PH: study design, critical revision. CH: critical revision, device manager, data analysis.

    • 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; internally peer reviewed.