Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods

Background: The fixation of an endotracheal tube must be rapid in conditions involving numerous casualties, such as a chemical warfare (CW) situation. The tube also should be fixed and strong to prevent unplanned extubations. Methods: We developed a technique for the evaluation of fixation methods. This technique was used to evaluate four methods. Three commercial fixators were compared with the fixation method used today in the Israeli Defense Forces (IDF) and commonly used in different out-of-hospital settings. The exercises were performed on adult intubation mannequins with and without CW protective gear. The fixations were timed, and their quality was evaluated by the participants and inspectors. Results: The time score for the method used today in the IDF was significantly higher compared with the commercial fixation methods. The quality scores for the Thomas fixator and the IDF method were significantly higher than for the fixators by VBM and Rusch. The CW protective gear significantly prolonged the time but did not affect the quality of the fixation. Conclusions: With this technique, a good estimation of the time and quality of fixation can be achieved.