Résumé
Objectif
Les équipes prenant en charge un patient suspect de virose Ebola sont tenues au port d’équipements de protection individuelle (EPI) susceptibles d’entraver la dextérité des opérateurs. L’objectif principal est d’étudier l’impact des EPI Ebola sur la difficulté et le délai de réalisation des gestes d’urgence.
Matériel et méthodes
Cette étude observationnelle monocentrique croisée incluait 22 médecins urgentistes, réanimateurs ou infirmiers — anesthésistes volontaires devant réaliser cinq ateliers sur mannequin avec ou sans port d’EPI Ebola selon une séquence prédéterminée: voie veineuse périphérique (VVP), cathéter intraosseux (KTIO), intubation avec et sans Eschmann ou après pose de LMA-Fastrach™. Le critère de jugement principal était le délai de réalisation des gestes techniques avec et sans port d’EPI.
Résultats
Le port de l’EPI n’augmente pas le taux d’échec de chaque geste technique mais augmente significativement les délais d’intubation simple (29 vs 36 secondes; p < 0,01), d’intubation avec Eschmann (38 vs 45 secondes; p = 0,03) et l’intubation au LMA-Fastrach™(39 vs 45 secondes; p < 0,001). Le port d’EPI Ebola augmentait la difficulté ressentie pour la pose d’abords vasculaires sans augmenter le taux d’échec ni modifier les délais de pose de VVP. Le recours au KTIO était plus rapide que la pose de VVP sans (67 vs 88 secondes; p = 0,02) et avec tenue (78 vs 101 secondes; p < 0,01).
Conclusion
Le port de l’EPI n’entraîne qu’un impact modéré sur la dextérité des gestes techniques en situation d’urgence. Ces résultats doivent être confortés par des études cliniques.
Abstract
Background
Emergency or critical care physicians dealing with patients with Ebola virus disease (EVD) have to handle technical skills while wearing specific personal protective equipment (PPE).We thus aimed to assess the impact of Ebola-PPE for the completion of five emergency technical skills on training manikin.
Methods
Twenty-two volunteers were recruited to perform intubation with and without Eschmann tube, LMA-Fastrach ™ placement, insertion of an intravenous (IV) cannula and intra-osseous (IO) during a predefined sequence. The main endpoint was the time for completion of the five technical skills on manikin with and without Ebola-PPE in a random order.
Results
The success rate of the five technical skills whilst wearing Ebola-PPE was equivalent but significantly increased the time for simple intubation (29 vs 36 s; P < 0.01), intubation with Eschmann (38 vs 45 s; P = 0.03) and LMA-Fastrach™ placement (39 vs 45 s; P < 0.001). Wearing Ebola-PPE increased difficulty for vascular access without increasing the failure rate or change the time of installation VVP. IO insertion was faster than IV insertion access without PPE (67 vs 88 s; P = 0.02) and with PPE (78 vs 101 s; P = 0.007).
Conclusion
Ebola-PPE only resulted in a moderate impact for the completion of five emergency technical skills. These results should be reinforced by clinical studies.
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Bosc, J., Sanchez, O., Carrie, C. et al. Faisabilité des gestes d’urgence en tenue de protection individuelle du virus Ebola : pose d’abords vasculaires et contrôle des voies aériennes supérieures sur mannequin. Ann. Fr. Med. Urgence 6, 172–178 (2016). https://doi.org/10.1007/s13341-016-0631-2
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DOI: https://doi.org/10.1007/s13341-016-0631-2