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Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med 2023; 13:1327. [PMID: 37763095 PMCID: PMC10532647 DOI: 10.3390/jpm13091327] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
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Affiliation(s)
- Sophie A. Saul
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Patrick A. Ward
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Alistair F. McNarry
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
- Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK
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Pourmand A, Terrebonne E, Gerber S, Shipley J, Tran QK. Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis. Prehosp Disaster Med 2022; 38:1-11. [PMID: 36515070 DOI: 10.1017/s1049023x22002254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Placing an endotracheal tube is a life-saving measure. Direct laryngoscopy (DL) is traditionally the default method. Video laryngoscopy (VL) has been shown to improve efficiency, but there is insufficient evidence comparing VL versus DL in the prehospital settings. This study, comprising a systematic review and random-effects meta-analysis, assesses current literature for the efficacy of VL in prehospital settings. METHODS PubMed and Scopus databases were searched from their beginnings through March 1, 2022 for eligible studies. Outcomes were the first successful intubation, overall success rate, and number of total DL versus VL attempts in real-life clinical situations. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess heterogeneity. RESULTS The search yielded seven studies involving 23,953 patients, 6,674 (28%) of whom underwent intubation via VL. Compared to DL, VL was associated with a statistically higher risk ratio for first-pass success (Risk Ratio [RR] = 1.116; 95% CI, 1.005-1.239; P = .041; I2 = 87%). The I2 value for the subgroup of prospective studies was 0% compared to 89% for retrospective studies. In addition, VL was associated with higher likelihood of overall success rate (RR = 1.097; 95% CI, 1.01-1.18; P = .021; I2 = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; P = .008). CONCLUSION The meta-analysis suggested that VL was associated with higher likelihood of achieving first-pass success, greater overall success rate, and lower number of intubation attempts for adults in the prehospital settings. This study had high heterogeneity, likely presenced by the inclusion of retrospective observational studies. Further studies with more rigorous methodology are needed to confirm these results.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Emily Terrebonne
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Stephen Gerber
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Jeffrey Shipley
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MarylandUSA
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Behari D, Jaga R, Bergh K, Hofmeyr R. Intubation during spinal motion restriction using the LuboTM cervical collar - a manikin simulation study. Afr J Emerg Med 2022; 12:327-332. [PMID: 35919101 PMCID: PMC9334326 DOI: 10.1016/j.afjem.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The LuboTM collar is a cervical motion restriction device featuring a unique external jaw-thrust mechanism designed to provide non-invasive airway patency. In addition, tracheal intubation is facilitated by releasing an anterior chin strap; this allows better mouth opening than the previous generation of semi-rigid cervical collars. This study aimed to compare tracheal intubation using the LuboTM collar combined with manual in-line stabilization (MILS) to intubation with MILS alone. The primary outcome was the time to successful intubation. Secondary outcomes compared intubation success rate, Cormack-Lehane grade, ease of intubation and dental trauma. Methods A randomized, cross-over, equivalence study was performed. Eighty full-time physician anaesthesia providers were recruited. Participants performed tracheal intubation using direct laryngoscopy on a manikin under two different scenarios: with the LuboTM collar and MILS applied, and with MILS and no cervical collar. The time to successful intubation was measured and compared using two-one-sided and paired t-tests. Results Intubation times fell well within the a priori equivalence limits of 10 seconds, with a mean difference (95% CI) of 0.52 seconds (-1.30 to 2.56). There was no significant difference in intubation time with the LuboTM collar (mean [SD] 19.2 [4.5] seconds) compared to the MILS alone group (19.7 [5.2] seconds). The overall success rate was 98.7% in the Lubo group and 100% in the MILS group. Adequate laryngoscopy views (Cormack-Lehane grades I to IIb) were equivalent between groups (Lubo 92.5% versus MILS alone 93.7%). Conclusion In this manikin-based study, the time to intubation with the LuboTM collar and MILS applied was equivalent to time to intubation with MILS alone, with similar intubating conditions. Thus, the LuboTM collar and MILS may simplify airway management by reducing the number of steps required to perform intubation in patients requiring cervical motion restriction.
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The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility. Healthcare (Basel) 2022; 10:healthcare10091688. [PMID: 36141300 PMCID: PMC9498386 DOI: 10.3390/healthcare10091688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Among all the proposed predictors of difficult intubation defined by the intubation difficulty scale, head and neck movement (motility) stands out and plays as a crucial factor in determining the success rate and the degree of ease on endotracheal intubation. Aside from other airway tools (e.g., supraglottic airway devices), optical devices have been developed and applied for more than two decades and have shown their superiority to conventional direct laryngoscopes in many clinical scenarios and settings. Although awake/asleep flexible fiberoptic bronchoscopy is still the gold standard in patients with unstable cervical spines immobilized with a rigid cervical collar or a halo neck brace, videolaryngoscopy has been repeatedly demonstrated to be advantageous. In this brief report, for the first time, we present our clinical experience on the routine use of the Shikani video-assisted intubating stylet technique in patients with traumatic cervical spine injuries immobilized with a cervical stabilizer and in a patient with a stereotactic headframe for neurosurgery. Some trouble-shooting strategies for this technique are discussed. This paper demonstrates that the video-assisted intubating stylet technique is an acceptable alternative airway management method in patients with restricted or confined neck motility.
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Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J Clin Med 2021; 10:jcm10245740. [PMID: 34945036 PMCID: PMC8707195 DOI: 10.3390/jcm10245740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.
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Karczewska K, Bialka S, Smereka J, Cyran M, Nowak-Starz G, Chmielewski J, Pruc M, Wieczorek P, Peacock FW, Ladny JR, Szarpak L. Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10235524. [PMID: 34884226 PMCID: PMC8658072 DOI: 10.3390/jcm10235524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.
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Affiliation(s)
- Katarzyna Karczewska
- Department of Anesthesiology, Masovian Specialist Hospital, 26-617 Radom, Poland;
| | - Szymon Bialka
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Maciej Cyran
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | | | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Polonia University, 42-200 Czestochowa, Poland
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Bialystok Medical University, 15-295 Bialystok, Poland;
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-500-186-225
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García-Pintos MF, Erramouspe PJ, Schandera V, Murphy K, McCalla G, Taylor G, Tyler KR, Richards JR, Laurin EG. Comparison of Video Versus Direct Laryngoscopy: A Prospective Prehospital Air Medical Services Study. Air Med J 2021; 40:45-49. [PMID: 33455625 DOI: 10.1016/j.amj.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/19/2020] [Accepted: 10/29/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Videolaryngoscopy (VL) in the prehospital setting remains controversial, with conflicting data on its utility. We compared C-MAC VL (Karl Storz, Tuttlingen, Germany) versus direct laryngoscopy (DL) in the prehospital setting, recording the grade of the glottic view, first pass success (FPS), overall success, and equipment functionality. METHODS We conducted a prospective observational study with a convenience sample of 49 adult patients who were intubated by flight crew nurses and paramedics using the C-MAC videolaryngoscope from April to November 2013. We compared Cormack-Lehane (CL) grades of view for DL and VL, intubation success rates, and equipment functionality. RESULTS CL grades 1 or 2 were obtained with 24 patients (49%) with DL and 45 patients (92%) with VL. Of the 25 patients (51%) who had a CL grade 3 or 4 view on DL, 22 of those patients (88%) converted to a CL grade 1 or 2 with VL (P < .001). There was an overall success rate of 96% and an FPS rate of 71%. The C-MAC videolaryngoscope was functional during intubation 100% of the time. CONCLUSION VL improved glottic visualization compared with DL. The FPS and overall intubation success rates were similar to other published prehospital studies using VL. The C-MAC provided reliable, high-quality video despite demanding prehospital conditions.
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Affiliation(s)
| | - Pablo Joaquin Erramouspe
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA; Faculty of Health, Queensland University of Technology, Translational Research Institute, Brisbane, Queensland, Australia
| | - Verena Schandera
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Kevin Murphy
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA; Cottage Hospital, Santa Barbara, CA
| | | | - Greg Taylor
- REACH Air Medical Services, Santa Rosa, CA; Seattle Children's Hospital, Seattle, WA
| | - Katren R Tyler
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - John R Richards
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Erik G Laurin
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA
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Paik H, Park HP. Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine. BMC Anesthesiol 2020; 20:201. [PMID: 32799791 PMCID: PMC7429469 DOI: 10.1186/s12871-020-01118-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS In this randomized crossover study, the cervical spine angle was measured at the occiput-C1, C1-C2, and C2-C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation. RESULTS The cervical spine motion at the occiput-C1 segment was measured at 12.1 ± 4.2° and 6.8 ± 5.0° during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, - 5.3; 98.33% CI: - 8.8 to - 1.8; p = 0.001). However, there was no significant difference between the two intubation devices at the C1-C2 segment (- 0.6; 98.33% CI: - 3.4 to 2.2; p = 0.639) or C2-C5 segment (0.2; 98.33% CI: - 6.0 to 6.4; p = 0.929). CONCLUSIONS The C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov on June 26, 2018 ( NCT03567902 ).
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Affiliation(s)
- Hyesun Paik
- Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, 81, Saemaul-ro 177 gil, Bundang-gu, Seongnam, 13590, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Radiographic Predictors of Difficult McGrath MAC Videolaryngoscopy in Patient Undergoing Cervical Spine Surgery. J Neurosurg Anesthesiol 2020; 34:57-63. [PMID: 32658098 DOI: 10.1097/ana.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery. METHODS Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts. RESULTS In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation. CONCLUSIONS Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.
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Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial. Emerg Med Int 2019; 2019:7306204. [PMID: 31531242 PMCID: PMC6719269 DOI: 10.1155/2019/7306204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25-38); the time equalled 38s (IQR:31-44.5) in the standard bougie group and 47.5s (IQR:36-58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63-88), average in the standard bougie group (44, IQR:30-51), and highest in the new bougie stylet group (32, IQR:19-41). Conclusion In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.
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Ambu® AuraGain™ laryngeal mask as a method of airway management of patient entrapped in vehicle. Am J Emerg Med 2019; 37:171-172. [DOI: 10.1016/j.ajem.2018.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
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Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study. Eur J Pediatr 2019; 178:871-882. [PMID: 30903306 PMCID: PMC6511343 DOI: 10.1007/s00431-019-03345-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 10/31/2022]
Abstract
Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios.Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. What is Known: • For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation. • Endotracheal intubation is considered by many scientific societies the gold standard for airway management. • Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation. What is New: • The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. • It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.
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Comparison of Miller laryngoscope and UEScope videolaryngoscope for endotracheal intubation in four pediatric airway scenarios: a randomized, crossover simulation trial. Eur J Pediatr 2019; 178:937-945. [PMID: 30976922 PMCID: PMC6511341 DOI: 10.1007/s00431-019-03375-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022]
Abstract
With different videolaryngoscopes for pediatric patients available, UEScope can be used in all age groups. The aim of this study was to compare the Miller laryngoscope and UEScope in pediatric intubation by paramedics in different scenarios. Overall, 93 paramedics with no experience in pediatric intubation or videolaryngoscopy performed endotracheal intubation in scenarios: (A) normal airway without chest compressions, (B) difficult airway without chest compressions, (C) normal airway with uninterrupted chest compressions, (D) difficult airway with uninterrupted chest compressions. Scenario A. Total intubation success with both laryngoscopes: 100%. First-attempt success: 100% for UEScope, 96.8% for Miller. Median intubation time for UEScope: 13 s [IQR, 12.5-17], statistically significantly lower than for Miller: 14 s [IQR, 12-19.5] (p = 0.044). Scenario B. Total efficacy: 81.7% for Miller, 100% for UEScope (p = 0.012). First-attempt success: 48.4% for Miller, 87.1% for UEScope (p = 0.001). Median intubation time: 27 s [IQR, 21-33] with Miller, 15 s [IQR, 14-21] with UEScope (p = 0.001). Scenario C. Total efficiency: 91.4% with Miller, 100% with UEScope (p = 0.018); first-attempt success: 67.7 vs. 90.3% (p = 0.003), respectively. Intubation time: 21 s [IQR, 18-28] for Miller, 15 s [IQR, 12-19.5] for UEScope. Scenario D. Total efficiency: 65.6% with Miller, 98.9% with UEScope (p < 0.001); first-attempt success: 29.1 vs. 72% (p = 0.001), respectively. Intubation time: 38 s [IQR, 23-46] for Miller, 21 s [IQR, 17-25.5] for UEScope.Conclusion: In pediatric normal airway without chest compressions, UEScope is comparable with Miller. In difficult pediatric airways without chest compressions, UEScope offers better first-attempt success, shorted median intubation time, and improved glottic visualization. With uninterrupted chest compressions in normal or difficult airway, UEScope provides a higher first-attempt success, a shorter median intubation time, and a better glottic visualization than Miller laryngoscope. What is Known: • Endotracheal intubation is the gold standard for adult and children airway management. • More than two direct laryngoscopy attempts in children with difficult airways are associated with a high failure rate and increased incidence of severe complications. What is New: • In difficult pediatric airways with or without chest compressions, UEScope in inexperienced providers in simulated settings provides better first-attempt efficiency, median intubation time, and glottic visualization.
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Bielski A, Rivas E, Ruetzler K, Smereka J, Puslecki M, Dabrowski M, Ladny JR, Frass M, Robak O, Evrin T, Szarpak L. Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand: Randomized, crossover manikin trial. Medicine (Baltimore) 2018; 97:e12593. [PMID: 30290627 PMCID: PMC6200544 DOI: 10.1097/md.0000000000012593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation. METHODS The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression. RESULTS Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35-49), compared with Air-Q (21 seconds, 18-32) and I-Gel (19 seconds, 17-27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001). CONCLUSIONS Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.
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Affiliation(s)
| | - Eva Rivas
- Department of Anesthesiology, Hospital Clinic, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kurt Ruetzler
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw
| | - Mateusz Puslecki
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Marek Dabrowski
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
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Gawel WB, Kaminska H, Wieczorek W. The efficacy of endotracheal intubation utilizing INTUBRITE laryngoscope during cardiopulmonary resuscitation. Am J Emerg Med 2018; 36:1895-1896. [DOI: 10.1016/j.ajem.2018.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/29/2022] Open
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Evrin T, Kaminska H, Wieczorek W. Paramedics attitudes toward endotracheal intibation. Am J Emerg Med 2018; 36:1700-1701. [DOI: 10.1016/j.ajem.2018.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/30/2022] Open
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17
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Szarpak L, Madziala A, Czekajlo M, Smereka J, Kaserer A, Dabrowski M, Madziala M, Yakubtsevich R, Ladny JR, Ruetzler K. Comparison of the UEScope videolaryngoscope with the Macintosh laryngoscope during simulated cardiopulmonary resuscitation: A randomized, cross-over, multi-center manikin study. Medicine (Baltimore) 2018; 97:e12085. [PMID: 30200089 PMCID: PMC6133438 DOI: 10.1097/md.0000000000012085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endotracheal intubation (ETI) can be challenging, especially in life-threatening situations such as cardiopulmonary resuscitation (CPR). Videolaryngoscopes aim to ease ETI, but effort is still widely discussed. This study intended to investigate 2 different airway devices regarding the success rate of ETI during ongoing chest compressions. METHODS This randomized, cross-over, multi-center manikin trial included 85 experienced paramedics actively working in the emergency medicine service. After a standardized training session, all paramedics underwent 3 airway scenarios using both, direct laryngoscopy using a Macintosh blade and videolaryngoscope (the UEScope): normal airway without chest compressions, normal airway with uninterrupted chest compressions, and difficult airway with uninterrupted chest compressions. The primary outcome was successful ETI, defined as successful placement of the endotracheal tube within the manikin's trachea. Secondary outcomes were number of intubation attempts, time to successful ETI, time to best glottis view, best percent of glottic opening, best glottic view score (Cormack and Lehane), occurrence of dental trauma, ease of use, and willing to reuse in real-life situations. RESULTS The UEScope provided a better glottis visualization, and higher first pass intubation success rate compared to direct laryngoscopy in all 3 scenarios. The overall intubation success was higher, and the intubation time was shorter with the UEScope in scenario B and scenario C, but was comparable in scenario A. Dental compression occurred less often using the UEScope and paramedics rated intubation using the UEScope easier compared to direct laryngoscopy in all 3 airway scenarios. CONCLUSION In simulated CPR scenarios, intubation with the UEScope resulted in a better glottis visualization, a higher intubation success, and a shorter intubation time compared to Macintosh laryngoscope (MAC). Moreover, in situations where the airway is difficult for ETI especially by the paramedic, the UEScope would be a better choice than the MAC. Further studies are needed to confirm these results in real-life patients.
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Affiliation(s)
| | - Agnieszka Madziala
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michael Czekajlo
- Department of Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, VA
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Marek Dabrowski
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Ruslan Yakubtsevich
- Department of Anesthesiology and Intensive Care Grodno State Medical University, Grodno, Belarus
| | - Jerzy Robert Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Cleveland, OH
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Szarpak L. Laryngoscopes for difficult airway scenarios: a comparison of the available devices. Expert Rev Med Devices 2018; 15:631-643. [PMID: 30099914 DOI: 10.1080/17434440.2018.1511423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION According to the American Society of Anesthesiologists, the incidence of difficult intubation in the operating room is 1.2-3.8%; however, in emergency conditions, this rate is higher and reaches even 5.3%. Successful emergency airway management is an essential component of the modern practice of medicine. AREAS COVERED The aim of the study is to review the literature regarding different devices used to perform endotracheal intubation (Macintosh, Miller, and McCoy laryngoscopes; ETView, GlideScope, TruView, Airtraq, McGrath MAC, Pentax AWS, Trachlight, Shikani, and Bullard) and discuss their clinical and experimental role in difficult airway management. EXPERT COMMENTARY Owing to the development of medical technology, there are an increasing number of videolaryngoscopes and other devices facilitating endotracheal intubation in difficult airway scenarios, including cardiopulmonary resuscitation, cervical spine injury, or face-to-face intubation. Each of these devices may bring benefits in the form of increasing the intubation effectiveness, as well as shortening the procedure, provided that the person performing intubation is familiar with the use of the device.
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Affiliation(s)
- Lukasz Szarpak
- a Faculty of Medicine , Lazarski University , Warsaw , Poland
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Evrin T, Iskrzycki L, Gawlowski P. The usage of Ambu® AuraGain™ laryngeal mask airway by the lifeguards. Am J Emerg Med 2018; 36:2331-2332. [PMID: 29709401 DOI: 10.1016/j.ajem.2018.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, UFuK University, Ankara, Turkey; Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Lukasz Iskrzycki
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
| | - Pawel Gawlowski
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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Kalopita K, Michala L, Theofanakis C, Valsamidis D. Anesthetic management of mosaic Turner’s syndrome posted for elective cesarean delivery after spontaneous pregnancy. Int J Obstet Anesth 2018; 34:102-105. [DOI: 10.1016/j.ijoa.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/24/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
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Normand KC, Vargas LA, Burnett T, Sridhar S, Cai C, Zhang X, Markham TH, Guzman-Reyes S, Hagberg CA. Use of the McGRATH™ MAC: To view or not to view? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evrin T, Madziala M. iGEL vs laryngeal tube for airway management during a normal airway scenario. Am J Emerg Med 2018. [PMID: 29519762 DOI: 10.1016/j.ajem.2018.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Marcin Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Poland.
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Brodecki M, Sosnowski A, Madziala M. Comparison of Macintosh and Miller laryngoscopes during pediatric resuscitation. Am J Emerg Med 2018; 36:1098-1099. [PMID: 29496366 DOI: 10.1016/j.ajem.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Andrzej Sosnowski
- Norber Barlicki Memorial University Clinical Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Marcin Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Poland
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Kaminska H, Wieczorek W. Comparison of two types of laryngoscopy for face-to-face intubation of a patient entrapped in a vehicle. Am J Emerg Med 2018; 36:1898-1899. [PMID: 29429795 DOI: 10.1016/j.ajem.2018.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Halla Kaminska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wieczorek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
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Kaminska H, Gawel WB, Wieczorek W. Which option for ventilation is optimal for resuscitation performed by nurses? Pilot data. Am J Emerg Med 2018; 36:1710-1711. [PMID: 29395777 DOI: 10.1016/j.ajem.2018.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Halla Kaminska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Wladysław B Gawel
- Student's Scientific Association of Children's Diabetology of Medical University of Silesia, Poland
| | - Wojciech Wieczorek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
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Madziala A, Cieciel M, Konski R, Madziala M. An endotracheal tube mounted camera for intubation during cardiopulmonary resuscitation. Preliminary data. Am J Emerg Med 2018; 36:1897-1898. [PMID: 29396324 DOI: 10.1016/j.ajem.2018.01.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Agnieszka Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland
| | - Michal Cieciel
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Roman Konski
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Poland.
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McNarry A, Patel A. The evolution of airway management – new concepts and conflicts with traditional practice. Br J Anaesth 2017; 119:i154-i166. [DOI: 10.1093/bja/aex385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Klosiewicz T, Zalewski R, Dabrowska A, Maciejewski A. Emergency intubation in prehospital care. Am J Emerg Med 2017; 35:1775-1776. [DOI: 10.1016/j.ajem.2017.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022] Open
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Wang SY, Xue FS, Yang GZ, Liu YY. Performance of C-MAC videolaryngoscope for intubation in cervical spine immobilization conditions. Am J Emerg Med 2017; 36:1117-1118. [PMID: 29074069 DOI: 10.1016/j.ajem.2017.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Shi-Yu Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Dabrowski M, Dabrowska A, Sip M. Videolaryngoscopy for trauma patient intubation. Am J Emerg Med 2017; 35:1564-1565. [PMID: 28413124 DOI: 10.1016/j.ajem.2017.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Marek Dabrowski
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Simulation Medicine, Poland.
| | - Agata Dabrowska
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Simulation Medicine, Poland
| | - Maciej Sip
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Simulation Medicine, Poland
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