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Endotracheal tube fixation time: a comparison of three fixation methods in a military field scenario
  1. Danny Epstein1,2,
  2. R Strashewsky3,
  3. A Furer2,
  4. A M Tsur2,
  5. J Chen2 and
  6. A Lehavi3,4
  1. 1 Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
  2. 2 Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
  3. 3 Department of Anesthesiology, Rambam Health Care Campus, Haifa, Haifa, Israel
  4. 4 Department of Anesthesiology, Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Haifa, Israel
  1. Correspondence to Dr Danny Epstein, Department of internal medicine B, Rambam Health Care Campus, Haifa 3109601, Israel; danyep{at}gmail.com

Abstract

Introduction Endotracheal intubation is required in many emergency, trauma and prehospital scenarios. Endotracheal tube (ETT) fixation must be stable and quick to apply to enable rapid evacuation and patient transport. This study compares performance times of three common ETT securement techniques which are practical for out-of-hospital and combat scenarios.

Methods We compared the time required by military medics to complete ETT fixation in three techniques—fixation of a wide gauze roll wrapped twice around the head and tied twice around the ETT (GR), using a Thomas Tube Holder (TH) and using a pre-tied non-adhesive tape (PT). 300 military medics were randomised to apply one technique each on a manikin, and time to completion was recorded.

Results 300 ETTs were successfully fixated by 300 military medics. Median times to complete ETT fixation by PT and TH techniques were 24 s (IQR (19 to 31) and (IQR 20 to 33), respectively). Both were significantly shorter to apply than the GR technique, with a median time of 57 s (IQR 47 to 81), p<0.001.

Conclusions In time critical situations such as combat, severe trauma, mass casualties and whenever rapid evacuation might improve the clinical outcome, using a faster fixation technique such as Thomas Tube Holder or a pre-tied non-adhesive tape might enable faster evacuation than the use of traditional endotracheal tube fixation techniques.

  • adult intensive & critical care
  • trauma management
  • adult anaesthesia
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Footnotes

  • Contributors Dr DE conceived the idea for the study, designed the study and analysed the data, performed the statistical analysis and drafted the manuscript. Dr RS designed the study, collected and analysed the data and drafted the manuscript. Dr AF collected the data, reviewed the manuscript and approved the final manuscript as submitted. Dr AMT contributed to the conceptualisation of the study and interpretation of the results, reviewed the manuscript and approved the final manuscript as submitted. Dr JC critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr AL conceived the idea for the study, designed the study, analysed the data, critically reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval requirement was waived by the Institutional Review Board as this is a laboratory investigation without the involvement of neither human nor animal subjects. The participation in the study was solely voluntary.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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