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Xu X, Ma H, Zhang Y, Liu W, Jung B, Li X, Shen L. Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial. BMC Anesthesiol 2024; 24:181. [PMID: 38773386 PMCID: PMC11106944 DOI: 10.1186/s12871-024-02560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. METHODS This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. RESULTS A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. CONCLUSIONS The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. TRIAL REGISTRATION Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yuelun Zhang
- Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Xu Li
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
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Chien YT, Ong JR, Tam KW, Loh EW. Video laryngoscopy and direct laryngoscopy for cardiac arrest: A meta-analysis of clinical studies and trials. Am J Emerg Med 2023; 73:116-124. [PMID: 37647846 DOI: 10.1016/j.ajem.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Intubation is an essential procedure in cardiopulmonary resuscitation (CPR). We conducted a systematic review and meta-analysis of trials and studies comparing the performance of video laryngoscope (VL) and direct laryngoscope (DL) in endotracheal intubation (ETI) during CPR in cardiac arrest (OHCA) patients. METHODS We searched the PUBMED, EMBASE, and Cochrane library databases. We analyzed the first-pass success rate, total intubation time, Cormack-Lehane grade (CL grade), esophageal intubation rate, and dental injury rate among the in-hospital cardiac arrest (IHCA) patients or out-of-hospital cardiac arrest (OHCA) patients. We demonstrated the pooled results of continuous outcomes by mean difference (MD) and dichotomous outcomes by odds ratio (OR), with a 95% confidence interval (CI) using a random-effects model. RESULTS We obtained six observational studies and one randomized control trial. The pooled results showed a significant increase in first-pass success rate (OR: 1.86, 95% CI: 1.41, 2.47), Cormack-Lehane (CL) grade (OR: 2.01, 95% CI: 1.59,2.53), and a decrease of esophageal intubation rate (OR: 0.25, 95% CI: 0.08, 0.85) in the VL group compared with DL group. Also, a non-significant decrease in dental injury rate [OR: 0.23, 95% CI: 0.05, 1.08) was observed in the VL group compared with the DL group. There was no statistical difference between the VL and DL groups, although the VL group seemed to have a shorter total intubation time (MD: -15.43, 95% CI: -34.67, 3.81). Types of laryngoscopes were not associated with the rate of ROSC [OR 1.01 (0.95,1.07); P = 0.83]. No differences in survival outcomes were observed between the two approaches. CONCLUSIONS Compared to DL, VL was found to be associated with first-pass success and CL grade. We recommend prioritizing VL over DL when performing ETIs for patients with cardiac arrest.
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Affiliation(s)
- Yu-Ta Chien
- Department of Emergency Medicine, Mennonite Christian Hospital, Emergency Department, Hualien City, Taiwan
| | - Jiann-Ruey Ong
- Department of Emergency Medicine, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Medical Imaging, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
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Strandqvist E, Olheden S, Bäckman A, Jörnvall H, Bäckström D. Physician-staffed prehospital units: a retrospective follow-up from an urban area in Scandinavia. Int J Emerg Med 2023; 16:43. [PMID: 37452288 PMCID: PMC10349430 DOI: 10.1186/s12245-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The aim of this study was to determine when and how rapid response vehicles (RRVs) make a difference in prehospital care by investigating the number and kinds of RRV assignment dispatches and the prehospital characteristics and interventions involved. METHODS This retrospective cohort study was based on data from a quality assurance system where all assignments are registered. RRV staff register every assignment directly at the site, using a smartphone, tablet, or computer. There is no mandatory information requirement or time limit for registration. The study includes data for all RRVs operating in Region Stockholm, three during daytime hours and one at night - from January 1, 2021 to December 31, 2021. RESULTS In 2021, RRVs in Stockholm were dispatched on 11,283 occasions, of which 3,571 (31.6%) resulted in stand-downs. In general, stand-downs were less common for older patients. The most common dispatch category was blunt trauma (1,584 or 14.0%), which accounted for the highest frequency of stand-downs (676 or 6.0%). The second most common category was cardiac arrest (1,086 or 9.6%), followed by shortness of breath (691 or 6.1%), medical not specified (N/S) (596 or 5.3%), and seizures (572 or 5.1%). CONCLUSION The study findings confirm that RRVs provide valuable assistance to the ambulance service in Stockholm, especially for cardiac arrest and trauma patients. In particular, RRV personnel have more advanced medical knowledge and can administer medications and perform interventions that the regular ambulance service cannot provide.
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Affiliation(s)
| | - Staffan Olheden
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
| | - Anders Bäckman
- Capio Akutläkarbilar, Stockholm, Sweden
- Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Henrik Jörnvall
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Denise Bäckström
- Capio Akutläkarbilar, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Aziz MF, Berkow L. Pro-Con Debate: Videolaryngoscopy Should Be Standard of Care for Tracheal Intubation. Anesth Analg 2023; 136:683-688. [PMID: 36928154 DOI: 10.1213/ane.0000000000006252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
In this Pro-Con commentary article, we discuss whether videolaryngoscopy (VL) should be the standard of care for tracheal intubation. Dr Aziz makes the case that VL should be the standard of care, while Dr Berkow follows with a challenge of that assertion. In this debate, we explore not only the various benefits of VL, but also its limitations. There is compelling evidence that VL improves first-pass success rates, reduces the risk of intubation failure and esophageal intubation, and has benefits in the difficult airway patient. But VL is not without complications and does not possess a 100% success rate. In the case of failure, it is important to have back-up plans for airway management. While transition of care from direct laryngoscopy (DL) to VL may result in improved airway management outcomes, the reliance on VL may degrade other important clinical skills when they are needed most. If VL is adapted as the standard of care, airway managers may no longer practice and retain competency in other airway techniques that may be required in the event of VL failure. While cost is a barrier to broad implementation of VL, those costs are normalizing. However, it may still be challenging for institutions to secure purchase of VL for every intubating location, as well as back-up airway devices. As airway management care increasingly transitions from DL to VL, providers should be aware of the benefits and risks to this practice change.
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Affiliation(s)
- Michael F Aziz
- From the Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
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Risse J, Fischer M, Meggiolaro KM, Fariq-Spiegel K, Pabst D, Manegold R, Kill C, Fistera D. Effect of video laryngoscopy for non-trauma out-of-hospital cardiac arrest on clinical outcome: A registry-based analysis. Resuscitation 2023; 185:109688. [PMID: 36621529 DOI: 10.1016/j.resuscitation.2023.109688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
AIM Videolaryngoscopy (VL) is a promising tool to provide a safe airway during cardiopulmonary resuscitation (CPR) and to ensure early reoxygenation. Using data from the German Resuscitation Registry, we investigated the outcome of non-traumatic out-of-hospital cardiac arrest (OHCA) patients treated with VL versus direct laryngoscopy (DL) for airway management. METHODS We analysed retrospective data of 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories one and two (CPC1/2). Secondary endpoints were the rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used multivariate binary logistic regression analysis to identify the effects on outcome of known influencing variables and of VL vs DL. RESULTS The multivariate regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.34, 95% CI = 1.12-1.61, p = 0.002) and of hospital discharge/30-day survival (OR = 1.26, 95% CI = 1.08-1.47, p = 0,004). CONCLUSION VL for endotracheal intubation (ETI) at OHCA was associated with better neurological outcome in patients with ROSC. Therefore, the use of VL for OHCA offers a promising perspective. Further prospective studies are required.
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Affiliation(s)
- Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Germany.
| | - Matthias Fischer
- Department of Anaesthesiology and Intensive Care, ALB FILS Hospital, Göppingen, Germany.
| | - Karl Matteo Meggiolaro
- Department of Anaesthesiology and Intensive Care Medicine, Philipps-University Marburg, Germany.
| | | | - Dirk Pabst
- Center of Emergency Medicine, University Hospital Essen, Germany.
| | - Randi Manegold
- Center of Emergency Medicine, University Hospital Essen, Germany.
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Germany.
| | - David Fistera
- Center of Emergency Medicine, University Hospital Essen, Germany.
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Tracheal Intubation during Advanced Life Support Using Direct Laryngoscopy versus Glidescope ® Videolaryngoscopy by Clinicians with Limited Intubation Experience: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11216291. [PMID: 36362519 PMCID: PMC9655434 DOI: 10.3390/jcm11216291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
The use of the Glidescope® videolaryngoscope might improve tracheal intubation performance in clinicians with limited intubation experience, especially during cardiopulmonary resuscitation (CPR). The objective of this systematic review and meta-analysis is to compare direct laryngoscopy to Glidescope® videolaryngoscopy by these clinicians. PubMed/Medline and Embase were searched from their inception to 7 July 2020 for randomized controlled trials, including simulation studies. Studies on adult patients or adult-sized manikins were included when direct laryngoscopy was compared to Glidescope® videolaryngoscopy by clinicians with limited experience in tracheal intubation (<10 intubations per year). The primary outcome was the intubation first-pass success rate. Secondary outcomes were time to successful intubation and chest compression interruption duration during intubation. The risk of bias was assessed with the Cochrane risk of bias tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). We included 4 clinical trials with 525 patients and 20 manikin trials with 2547 intubations. Meta-analyses favored Glidescope® videolaryngoscopy over direct laryngoscopy regarding first-pass success (clinical trials: risk ratio [RR] = 1.61; 95% confidence interval [CI]: 1.16−2.23; manikin trials: RR = 1.17; 95% CI: 1.09−1.25). Clinical trials showed a shorter time to achieve successful intubation when using the Glidescope® (mean difference = 17.04 s; 95% CI: 8.51−25.57 s). Chest compression interruption duration was decreased when using the Glidescope® videolaryngoscope. The certainty of evidence ranged from very low to moderate. When clinicians with limited intubation experience have to perform tracheal intubation during advanced life support, the use of the Glidescope® videolaryngoscope improves intubation and CPR performance compared to direct laryngoscopy.
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7
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Videolaryngoscopy versus direct laryngoscopy for endotracheal intubation of cardiac arrest patients in hospital: A systematic literature review. Resusc Plus 2022; 11:100297. [PMID: 36111271 PMCID: PMC9468586 DOI: 10.1016/j.resplu.2022.100297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Aims Airway management during cardiopulmonary resuscitation may involve endotracheal intubation complicated by associated difficulties. Videolaryngoscopy may help to ease these difficulties and increase success rates by removing the need to achieve a direct line of sight required by standard direct laryngoscopy. This literature review aims to establish if there is an overall benefit in using videolaryngoscopy over direct laryngoscopy when intubating patients during cardiac arrest in the non-theatre hospital environment. Methods The review was registered on PROSPERO (record ID 329987). A systematic search was conducted of EMBASE, MEDLINE, CINAHL and Web of Science for literature comparing the use of videolaryngoscopy to direct laryngoscopy during intubation of cardiac arrest patients in hospital up until 4th May 2022. The Cochrane Central Register of Controlled Trials (CENTRAL) database was accessed, and reference lists of relevant systematic reviews were analysed for further papers. Forward and backward citation tracking was carried out of the shortlisted papers to hand-search for any further relevant studies. Papers were included in the review if they used adult patients, the patients were intubated during cardiac arrest in hospital and if the papers were in English language or had an accessible translation. Papers were excluded if patients were intubated not during cardiac arrest, the studies were based outside of a hospital setting or in the operating theatre, the patients were paediatric or if the study used a simulation or manikin. The Critical Appraisal Skills Programme checklists were used to assess risk of bias. Odds ratios, confidence intervals and probability values were used to synthesise results. Results Six studies were identified that collectively analysed 4525 patients who were intubated during cardiac arrest in the non-theatre hospital environment; five studies were observational and one a randomised controlled trial. Most of the studies being observational in nature led to a significant bias in their methodology which is a limitation to this review. The studies all measured first pass success rate as the primary outcome. First pass success rate only improved with videolaryngoscopy compared to direct laryngoscopy when the intubator was a less experienced clinician. Videolaryngoscopy also reduced some endotracheal intubation related complications and improved glottic visualisation when compared to direct laryngoscopy. Conclusion The limited data suggests that use of videolaryngoscopy improved first pass success rates compared to direct laryngoscopy when the clinician was less experienced.
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8
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Ruderman B, Mali M, Kaji A, Kilgo R, Watts S, Wells R, Limkakeng A, Borawski J, Fantegrossi A, Walls R, Brown C. Direct vs Video Laryngoscopy for Difficult Airway Patients in the Emergency Department: A National Emergency Airway Registry Study. West J Emerg Med 2022; 23:706-715. [PMID: 36205675 PMCID: PMC9541990 DOI: 10.5811/westjem.2022.6.55551] [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: 12/06/2021] [Accepted: 06/23/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways.
Methods: We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016–December 2018). Variables included demographics, indications, methods, medications, devices, difficult airway characteristics, success, and adverse events. We included adult ED patients intubated with VL or DL who had difficult airways identified by gestalt or anatomic predictors. We stratified VL by hyperangulated (HAVL) vs standard geometry VL (SGVL). The primary outcome was FPS, and the secondary outcome was comparison of adverse event rates between groups. Data analyses included descriptive statistics with cluster-adjusted 95% confidence intervals (CI).
Results: Of 18,123 total intubations, 12,853 had a predicted or identified anatomically difficult airway. The FPS for difficult airways was 89.1% (95% CI 85.9-92.3) with VL and 77.7% (95% CI 75.7-79.7) with DL (P <0.00001). The FPS rates were similar between VL subtypes for all difficult airway characteristics except airways with blood or vomit, where SGVL FPS (87.3%; 95% CI 85.8-88.8) was slightly better than HAVL FPS (82.4%; 95% CI, 80.3-84.4). Adverse event rates were similar except for esophageal intubations and vomiting, which were both less common in VL than DL. Esophageal intubations occurred in 0.4% (95% CI 0.1-0.7) of VL attempts and 1.5% (95% CI 1.1-1.9) of DL attempts. Vomiting occurred in 0.6% (95% CI 0.5-0.7) of VL attempts and 1.4% (95% CI 0.9-1.9) of DL attempts.
Conclusion: Analysis of the NEAR database demonstrates higher first-pass success with VL compared to DL in patients with predicted or anatomically difficult airways, and reduced rate of esophageal intubations and vomiting.
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Affiliation(s)
- Brandon Ruderman
- Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina
| | - Martina Mali
- Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas
| | - Amy Kaji
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California
| | - Robert Kilgo
- Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas
| | - Susan Watts
- Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas
| | - Radosveta Wells
- Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas
| | - Alexander Limkakeng
- Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina
| | - Joseph Borawski
- Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina
| | - Andrea Fantegrossi
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Ron Walls
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Calvin Brown
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Keresztes D, Mérei Á, Rozanovic M, Nagy E, Kovács-Ábrahám Z, Oláh J, Maróti P, Rendeki S, Nagy B, Woth G. Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices. PLoS One 2021; 16:e0260140. [PMID: 34793558 PMCID: PMC8601572 DOI: 10.1371/journal.pone.0260140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/03/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. Materials and methods Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. Results In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. Conclusion All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.
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Affiliation(s)
- Dóra Keresztes
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
- * E-mail:
| | - Ákos Mérei
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
| | - Martin Rozanovic
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
| | - Edina Nagy
- Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Kovács-Ábrahám
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
| | - János Oláh
- Medical School, University of Pécs, Pécs, Hungary
| | - Péter Maróti
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Rendeki
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Woth
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. [Adult advanced life support]. Notf Rett Med 2021; 24:406-446. [PMID: 34121923 PMCID: PMC8185697 DOI: 10.1007/s10049-021-00893-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Köln, Köln, Deutschland
| | - Pierre Carli
- SAMU de Paris, Center Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, Frankreich
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
- Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, Großbritannien
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Großbritannien
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Schweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Schweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italien
| | - Gavin D. Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, Großbritannien
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rom, Italien
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rom, Italien
| | - Jerry P. Nolan
- Warwick Medical School, Coventry, Großbritannien, Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, University of Warwick, Bath, Großbritannien
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11
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 454] [Impact Index Per Article: 151.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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12
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Knapp J, Eberle B, Bernhard M, Theiler L, Pietsch U, Albrecht R. Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy. Scand J Trauma Resusc Emerg Med 2021; 29:49. [PMID: 33731197 PMCID: PMC7968290 DOI: 10.1186/s13049-021-00863-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Bettina Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.,Department of Anaesthesiology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Michael Bernhard
- Emergency Department, Heinrich-Heine-University, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Lorenz Theiler
- Department of Anaesthesiology, Cantonal Hospital of Aargau, Aarau, Switzerland.,Swiss Air Rescue, Rega, Zurich, Switzerland
| | - Urs Pietsch
- Swiss Air Rescue, Rega, Zurich, Switzerland.,Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roland Albrecht
- Swiss Air Rescue, Rega, Zurich, Switzerland.,Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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13
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Video laryngoscopy for out of hospital cardiac arrest. Resuscitation 2021; 162:143-148. [PMID: 33640431 DOI: 10.1016/j.resuscitation.2021.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Endotracheal intubation is an import component of out-of-hospital cardiac arrest (OHCA) resuscitation. In this analysis, we evaluate the association of video laryngoscopy (VL) with first pass success and return of spontaneous circulation (ROSC) using a national OHCA cohort. METHODS We analyzed 2018 data from ESO Inc. (Austin, TX), a national prehospital electronic health record. We included all adult, non-traumatic cardiac arrests undergoing endotracheal intubation. We defined VL and direct laryngoscopy (DL) based on paramedic recorded intubation device. The primary outcomes were first pass success, ROSC, and sustained ROSC. Using multivariable, mixed models, we determined the association between VL and first pass success rate, ROSC, and sustained ROSC (survival to ED or ROSC in the field for greater than 20 min), fitting agency as a random intercept and adjusting for confounders. RESULTS We included 22,132 patients cared for by 914 EMS agencies, including 5702 (25.7%) VL and 16,430 (74.2%) DL. Compared to DL, VL had a lower rate of bystander CPR, but other characteristics were similar between the groups. VL exhibited higher first pass success than DL (75.1% v 69.5%, p < .001). On mixed model analysis, VL was associated with a higher first pass success (OR 1.5, CI 1.3-1.6) but not ROSC (OR 1.1, CI 0.97-1.2) or sustained ROSC (OR 1.1, CI 0.9-1.2). CONCLUSION While associated with higher FPS, VL was not associated with increased rate of ROSC. The role of VL in OHCA remains unclear.
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Lesnick JA, Moore JX, Zhang Y, Jarvis J, Nichol G, Daya MR, Idris AH, Klug C, Dennis D, Carlson JN, Doshi P, Sopko G, Schmicker RH, Wang HE. Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial. Resuscitation 2021; 158:151-156. [PMID: 33278521 PMCID: PMC7855546 DOI: 10.1016/j.resuscitation.2020.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE While emphasized in clinical practice, the association between advanced airway insertion first-pass success (FPS) and patient outcomes is incompletely understood. We sought to determine the association of airway insertion FPS with adult out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). METHODS We performed a secondary analysis of PART, a multicenter clinical trial comparing LT and ETI upon adult OHCA outcomes. We defined FPS as successful LT insertion or ETI on the first attempt as reported by EMS personnel. We examined the outcomes return of spontaneous circulation (ROSC), 72-h survival, hospital survival, and hospital survival with favorable neurologic status (Modified Rankin Scale ≤3). Using multivariable GEE (generalized estimating equations), we determined the association between FPS and OHCA outcomes, adjusting for age, sex, witnessed arrest, bystander CPR, initial rhythm, and initial airway type. RESULTS Of 3004 patients enrolled in the trial, 1423 received LT, 1227 received ETI, 354 received bag-valve-mask ventilation only. FPS was: LT 86.2% and ETI 46.7%. FPS was associated with increased ROSC (aOR 1.23; 95%CI: 1.07-1.41)), but not 72-h survival (1.22; 0.94-1.58), hospital survival (0.90; 0.68-1.19) or hospital survival with favorable neurologic status (0.66; 0.37-1.19). CONCLUSION In adult OHCA, airway insertion FPS was associated with increased ROSC but not other OHCA outcomes. The influence of airway insertion FPS upon OHCA outcomes is unclear.
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Affiliation(s)
- Jason A Lesnick
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Justin X Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Yefei Zhang
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jeffrey Jarvis
- Williamson County Emergency Medical Services, Georgetown, TX, USA; Texas A&M Health Science Center, Temple, TX, USA
| | - Graham Nichol
- University of Washington[HYPHEN]Harborview Center for Prehospital Emergency Care, Departments of Medicine and Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cameron Klug
- Legacy Meridian Park Medical Center. Tualatin, OR, USA
| | | | - Jestin N Carlson
- University of Pittsburgh, Pittsburgh, PA, USA; Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, PA, USA
| | - Pratik Doshi
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - George Sopko
- National Institutes of Health, Bethesda, MD, USA
| | - Robert H Schmicker
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Henry E Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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15
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van Schuppen H, Boomars R, Kooij FO, den Tex P, Koster RW, Hollmann MW. Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:67-82. [PMID: 33742579 DOI: 10.1016/j.bpa.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Affiliation(s)
- Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - René Boomars
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Helicopter Mobile Medical Team (MMT), De Boelelaan 1117, Amsterdam, the Netherlands
| | - Paul den Tex
- University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Amsterdam Resuscitation Studies (ARREST), Meibergdreef 9, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands
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16
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Abstract
Airway management during cardiac arrest has undergone several advancements. Endotracheal intubation (ETI) often is considered the gold standard for airway management in cardiac arrest; however, other options exist. Recent prospective randomized trials have compared outcomes in bag-valve mask ventilation and supraglottic airways to ETI in out-of-hospital cardiac arrest. ETI, if performed early in resuscitation, is associated with worse patient outcomes and has been de-emphasized so as not to interfere with other aspects of the resuscitation. Hyperventilation has multiple theoretic harms during cardiac arrest, and methods, such as compression-adjusted ventilation, may be utilized to help reduce the incidence of hyperventilation.
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Affiliation(s)
- Jestin N Carlson
- Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, 232 West 25th Street, Erie, PA 16544, USA.
| | - Henry E Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, 64312 Fannin Street, JJL 434, Houston, TX 77030, USA
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Risse J, Volberg C, Kratz T, Plöger B, Jerrentrup A, Pabst D, Kill C. Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study. BMC Emerg Med 2020; 20:22. [PMID: 32293276 PMCID: PMC7092671 DOI: 10.1186/s12873-020-00316-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background Videolaryngoscopy (VL) has become a popular method of intubation (ETI). Although VL may facilitate ETI in less-experienced rescuers there are limited data available concerning ETI performed by paramedics during CPR. The goal was to evaluate the impact VL compared with DL on intubation success and glottic view during CPR performed by German paramedics. We investigated in an observational prospective study the superiority of VL by paramedics during CPR compared with direct laryngoscopy (DL). Methods In a single Emergency Medical Service (EMS) in Germany with in total 32 ambulances paramedics underwent an initial instruction from in endotracheal intubation (ETI) with GlideScope® (GVL) during resuscitation. The primary endpoint was good visibility of the glottis (Cormack-Lehane grading 1/2), and the secondary endpoint was successful intubation comparing GVL and DL. Results In total n = 97 patients were included, n = 69 with DL (n = 85 intubation attempts) and n = 28 VL (n = 37 intubation attempts). Videolaryngoscopy resulted in a significantly improved visualization of the larynx compared with DL. In the group using GVL, 82% rated visualization of the glottis as CL 1&2 versus 55% in the DL group (p = 0.02). Despite better visualization of the larynx, there was no statistically significant difference in successful ETI between GVL and DL (GVL 75% vs. DL 68.1%, p = 0.63). Conclusions We found no difference in Overall and First Pass Success (FPS) between GVL and DL during CPR by German paramedics despite better glottic visualization with GVL. Therefore, we conclude that education in VL should also focus on insertion of the endotracheal tube, considering the different procedures of GVL. Trial registration German Clinical Trial Register DRKS00020976, 27. February 2020 retrospectively registered.
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Affiliation(s)
- Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| | - Christian Volberg
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, 35033, Marburg, Germany
| | - Thomas Kratz
- Department of Anesthesia and Intensive Care Medicine, 21240 Talant, Côte-d'Or, Dijon, France
| | - Birgit Plöger
- Department of Emergency Medicine, Philipps-University Marburg, 35033, Marburg, Germany
| | - Andreas Jerrentrup
- Department of Emergency Medicine, Philipps-University Marburg, 35033, Marburg, Germany
| | - Dirk Pabst
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
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18
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Jiang J, Kang N, Li B, Wu AS, Xue FS. Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients-a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2020; 28:10. [PMID: 32033568 PMCID: PMC7006069 DOI: 10.1186/s13049-020-0702-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients. METHODS The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study. RESULTS Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03). CONCLUSIONS Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Na Kang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Ott T, Stracke J, Sellin S, Kriege M, Toenges G, Lott C, Kuhn S, Engelhard K. Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms. BMJ Open 2019; 9:e030430. [PMID: 31767584 PMCID: PMC6887030 DOI: 10.1136/bmjopen-2019-030430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES During a 'cannot intubate, cannot oxygenate' situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient's life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a 'cannot intubate, cannot oxygenate' situation. DESIGN Due to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study. SETTING We collected data in our institutional simulation centre between November 2016 and November 2017. PARTICIPANTS We included 40 experienced staff anaesthesiologists at our tertiary university hospital centre. INTERVENTION The participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records. PRIMARY OUTCOME MEASURES The difference in 'time to ventilation through cricothyrotomy' between the two situations was the primary outcome measure. RESULTS The results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3-40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time. CONCLUSION Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a 'cannot intubate, cannot oxygenate' situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Jascha Stracke
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Susanna Sellin
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Carsten Lott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
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20
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Jarvis JL, Wampler D, Wang HE. Association of patient age with first pass success in out-of-hospital advanced airway management. Resuscitation 2019; 141:136-143. [DOI: 10.1016/j.resuscitation.2019.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
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21
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C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation. ACTA ACUST UNITED AC 2019; 55:medicina55060225. [PMID: 31146497 PMCID: PMC6631212 DOI: 10.3390/medicina55060225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 01/06/2023]
Abstract
Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17-2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.
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Goto T, Goto Y, Hagiwara Y, Okamoto H, Watase H, Hasegawa K. Advancing emergency airway management practice and research. Acute Med Surg 2019; 6:336-351. [PMID: 31592072 PMCID: PMC6773646 DOI: 10.1002/ams2.428] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.
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Affiliation(s)
- Tadahiro Goto
- Graduate School of Medical Sciences University of Fukui Fukui Japan
| | - Yukari Goto
- Department of Emergency and Critical Care Nagoya University Hospital Nagoya Aichi Japan
| | - Yusuke Hagiwara
- Department of Pediatric Emergency and Critical Care Medicine Tokyo Metropolitan Children's Medical Centre Fuchu Tokyo Japan
| | - Hiroshi Okamoto
- Department of Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Hiroko Watase
- Department of Surgery University of Washington Seattle Washington
| | - Kohei Hasegawa
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts
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Comparison of video laryngoscopy versus direct laryngoscopy for intubation in emergency department patients with cardiac arrest: A multicentre study. Resuscitation 2018; 136:70-77. [PMID: 30385385 DOI: 10.1016/j.resuscitation.2018.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/18/2023]
Abstract
AIM To compare the tracheal intubation performance between video laryngoscopy (VL) and direct laryngoscopy (DL) in patients with cardiac arrest in the ED. METHODS This is an analysis of the data from a prospective, multicentre study of 15 EDs in Japan. We included consecutive adult patients with cardiac arrest who underwent intubation with VL or DL from 2012 through 2016. The primary outcome was first-attempt success. The secondary outcomes were glottic visualisation assessed with Cormack grade (1 vs. 2-4) and occurrence of oesophageal intubation. To examine the between-device difference in outcome risks, we analysed the whole data and 1:1 propensity score matched data. RESULTS Among 9694 patients who underwent intubation in the EDs, 3360 cardiac arrests (35%) were included in the analysis (90% were non-traumatic cardiac arrests). The first-attempt success rate was higher in the VL group compared to those in the DL (78% vs 70%; unadjusted OR 1.61 [95%CI 1.26-2.06] P < 0.001). This association remained significant after adjusting for six potential confounders and within-ED clustering (adjusted OR 1.33 [95%CI 1.03-1.73] P = 0.03). VL use was also associated with a better glottic visualisation (adjusted OR 3.84 [95%CI 2.81-5.26] P < 0.001) and lower rate of oesophageal intubation (adjusted OR 0.45 [95%CI 0.24-0.85] P = 0.01) compared to DL. These results were consistent in the propensity score matched analysis. CONCLUSIONS Based on large multicentre prospective data of ED patients with cardiac arrest, the use of VL was associated with a higher first-attempt success rate compared to DL, with a better glottic visualisation and lower oesophageal intubation rate.
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Smith CM, Yeung J. Airway management in cardiac arrest-Not a question of choice but of quality? Resuscitation 2018; 133:A5-A6. [PMID: 30336234 DOI: 10.1016/j.resuscitation.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Christopher M Smith
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Joyce Yeung
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
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Arulkumaran N, Lowe J, Ions R, Mendoza M, Bennett V, Dunser M. Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis. Br J Anaesth 2018; 120:712-724. [DOI: 10.1016/j.bja.2017.12.041] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 01/22/2023] Open
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Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit. Ann Am Thorac Soc 2018; 14:368-375. [PMID: 27983871 DOI: 10.1513/annalsats.201606-472oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Video laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening to place a tracheal tube. However, despite this advantage, a large number of attempts are unsuccessful. There are no existing data on anatomic characteristics in critically ill patients associated with a failed first attempt at laryngoscopy when using video laryngoscopy. OBJECTIVES To identify characteristics associated with first-attempt failure at intubation when using video laryngoscopy in the intensive care unit (ICU). METHODS This is an observational study of 906 consecutive patients intubated in the ICU with a video laryngoscope between January 2012 and January 2016 in a single-center academic medical ICU. After each intubation, the operator completed a data collection form, which included information on difficult airway characteristics, device used, and outcome of each attempt. Multivariable regression models were constructed to determine the difficult airway characteristics associated with a failed first attempt at intubation. MEASUREMENTS AND MAIN RESULTS There were no significant differences in sex, age, reason for intubation, or device used between first-attempt failures and first-attempt successes. First-attempt successes more commonly reported no difficult airway characteristics were present (23.9%; 95% confidence interval [CI], 20.7-27.0% vs. 13.3%; 95% CI, 8.0-18.8%). In logistic regression analysis of the entire 906-patient database, blood in the airway (odds ratio [OR], 2.63; 95% CI, 1.64-4.20), airway edema (OR, 2.85; 95% CI, 1.48-5.45), and obesity (OR, 1.59; 95% CI, 1.08-2.32) were significantly associated with first-attempt failure. Data collection on limited mouth opening and secretions began after the first 133 intubations, and we fit a second logistic model to examine cases in which these additional difficult airway characteristics were collected. In this subset (n = 773), the presence of blood (OR, 2.73; 95% CI, 1.60-4.64), cervical immobility (OR, 3.34; 95% CI, 1.28-8.72), and airway edema (OR, 3.10; 95% CI, 1.42-6.70) were associated with first-attempt failure. CONCLUSIONS In this single-center study, presence of blood in the airway, airway edema, cervical immobility, and obesity are associated with higher odds of first-attempt failure, when intubation was performed with video laryngoscopy in an ICU.
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Kriege M, Alflen C, Tzanova I, Schmidtmann I, Piepho T, Noppens RR. Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol. BMJ Open 2017; 7:e016907. [PMID: 28827261 PMCID: PMC5724220 DOI: 10.1136/bmjopen-2017-016907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients. METHODS AND ANALYSIS The EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications. ETHICS AND DISSEMINATION The project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT 02611986; pre-results.
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Affiliation(s)
- Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Christian Alflen
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Irene Tzanova
- Department of Anaesthesiology, Christophorus Hospital, Coesfeld, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Piepho
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Ruediger R Noppens
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Tracheal intubation remains a life-saving procedure that is typically not difficult for experienced providers in routine conditions. Unfortunately, difficult intubation remains challenging to predict and intubation conditions may make the event life threatening. Recent technological advances aim to further improve the ease, speed, safety, and success of intubation but have not been fully investigated. Video laryngoscopy, though proven effective in the difficult airway, may result in different intubation success rates in various settings and in different providers’ hands. The rescue surgical airway remains a rarely used but critical skill, and research continues to investigate optimal techniques. This review highlights some of the new thoughts and research on these important topics.
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Affiliation(s)
- Joelle Karlik
- Oregon Health & Science University, Portland, OR, USA
| | - Michael Aziz
- Oregon Health & Science University, Portland, OR, USA
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30
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Küßner T, Popp E. A – Atemweg. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis. Ann Am Thorac Soc 2016; 13:382-90. [PMID: 26653096 DOI: 10.1513/annalsats.201508-505oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however, existing comparative data on outcomes are limited. OBJECTIVES To compare first-attempt success and complication rates during intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit. METHODS We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding. MEASUREMENTS AND MAIN RESULTS A total of 809 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 136 (16.8%) using direct laryngoscopy. First-attempt success with video laryngoscopy was 80.4% (95% confidence interval [CI], 77.2-83.3%) compared with 65.4% (95% CI, 56.8-73.4%) for intubations performed with direct laryngoscopy (P < 0.001). In a propensity-matched analysis, the odds ratio for first-attempt success with video laryngoscopy versus direct laryngoscopy was 2.81 (95% CI, 2.27-3.59). The rate of arterial oxygen desaturation events during the first intubation attempt was significantly lower for video laryngoscopy than for direct laryngoscopy (18.3% vs. 25.9%; P = 0.04). The rate of esophageal intubation during any attempt was also significantly lower for video laryngoscopy (2.1% vs. 6.6%; P = 0.008). CONCLUSIONS Video laryngoscopy was associated with significantly improved odds of first-attempt success at tracheal intubation by nonanesthesiologists in a medical intensive care unit. Esophageal intubation and oxygen desaturation occurred less frequently with the use of video laryngoscopy. Randomized clinical trials are needed to confirm these findings.
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Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, Nguyen B, Ruetzler K, Szarpak L. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial. Medicine (Baltimore) 2016; 95:e5170. [PMID: 27858851 PMCID: PMC5591099 DOI: 10.1097/md.0000000000005170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. METHODS ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. RESULTS The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p < .001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT. CONCLUSIONS In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion, and cuff block were all found to be shorter with the ETView. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02733536.
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Affiliation(s)
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw
| | - Marcin Fudalej
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - 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
| | | | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Lukasz Szarpak
- Department of Emergency Medicine
- Correspondence: Lukasz Szarpak, Department of Emergency Medicine, Medical University of Warsaw, Lidleya 4 Str., 02-005 Warsaw, Polamd (e-mail: )
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Van Oeveren L, Donner J, Fantegrossi A, Mohr NM, Brown CA. Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study. Telemed J E Health 2016; 23:290-297. [PMID: 27673565 DOI: 10.1089/tmj.2016.0140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. INTRODUCTION We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. MATERIALS AND METHODS Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics. RESULTS Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia. DISCUSSION The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success. CONCLUSIONS Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.
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Affiliation(s)
- Lucas Van Oeveren
- 1 Section of Emergency Medicine, Avera McKennan Hospital , Sioux Falls, South Dakota.,2 Avera eCARE, Avera Health System , Sioux Falls, South Dakota
| | - Julie Donner
- 2 Avera eCARE, Avera Health System , Sioux Falls, South Dakota
| | - Andrea Fantegrossi
- 3 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Nicholas M Mohr
- 4 Department of Emergency Medicine, Division of Critical Care, University of Iowa Carver College of Medicine , Iowa City, Iowa.,5 Department of Anesthesia, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Calvin A Brown
- 3 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,6 Harvard Medical School , Boston, Massachusetts
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Natt B, Malo J, Hypes C, Sakles J, Mosier J. Strategies to improve first attempt success at intubation in critically ill patients. Br J Anaesth 2016; 117 Suppl 1:i60-i68. [DOI: 10.1093/bja/aew061] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 920] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Wang CH, Chen WJ, Chang WT, Tsai MS, Yu PH, Wu YW, Huang CH. The association between timing of tracheal intubation and outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2016; 105:59-65. [DOI: 10.1016/j.resuscitation.2016.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/29/2016] [Accepted: 05/20/2016] [Indexed: 01/02/2023]
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Kim JW, Park SO, Lee KR, Hong DY, Baek KJ, Lee YH, Lee JH, Choi PC. Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators. Resuscitation 2016; 105:196-202. [PMID: 27095126 DOI: 10.1016/j.resuscitation.2016.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Abstract
AIM This study compared endotracheal intubation (ETI) performance during cardiopulmonary resuscitation (CPR) between direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope(®)) by experienced intubators (>50 successful ETIs). METHODS This was a prospective randomized controlled study conducted in an emergency department between 2011 and 2013. Intubators who used DL or VL were randomly allocated to ETI during CPR. Data were collected from recorded video clips and rhythm sheets. The success, speed, complications, and chest compressions interruption were compared between the two devices. RESULTS Total 140 ETIs by experienced intubators using DL (n=69) and VL (n=71) were analysed. There were no significant differences between DL and VL in the ETI success rate (92.8% vs. 95.8%; p=0.490), first-attempt success rate (87.0% vs. 94.4%; p=0.204), and median time to complete ETI (51 [36-67] vs. 42 [34-62]s; p=0.143). In both groups, oesophageal intubation and dental injuries seldom occurred. However, longer chest compressions interruption occurred using DL (4.0 [1.0-11.0]s) compared with VL (0.0 [0.0-1.0]s) and frequent serious no-flow (interruption>10s) occurred with DL (18/69 [26.1%]) compared with VL (0/71) (p<0.001). For highly experienced intubators (>80 successful ETIs), frequent serious no-flow occurred in DL (14/55 [25.5%] vs. 0/57 in VL). CONCLUSIONS The ETI success, speed and complications during CPR did not differ significantly between the two devices for experienced intubators. However, the VL was superior in terms of completion of ETI without chest compression interruptions. TRIAL REGISTRATION Clinical Research Information Service (CRIS) in South Korea KCT0000849.
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Affiliation(s)
- Jong Won Kim
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dae Young Hong
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jeong Hun Lee
- Department of Emergency Medicine, College of Medicine, Dongguk University, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Pil Cho Choi
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Nolan JP, Ornato JP, Parr MJA, Perkins GD, Soar J. Resuscitation highlights in 2015. Resuscitation 2016; 100:A1-8. [PMID: 26803062 DOI: 10.1016/j.resuscitation.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 12/29/2022]
Affiliation(s)
- J P Nolan
- School of Clinical Sciences, University of Bristol, UK; Royal United Hospital, Bath, UK.
| | - J P Ornato
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | - M J A Parr
- University of New South Wales and Macquarie University, Sydney, Australia.
| | - G D Perkins
- University of Warwick, Warwick Medical School and Heart of England NHS Foundation Trust, Coventry CV4 7AL, UK.
| | - J Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
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Hinkelbein J, Cirillo F, De Robertis E, Spelten O. Update on video laryngoscopy in the emergency environment: The most important publications of the last 12 months. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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41
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Kurowski A, Szarpak L, Truszewski Z, Czyzewski L. Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?: A Randomized Crossover Manikin Study. Medicine (Baltimore) 2015; 94:e850. [PMID: 26020389 PMCID: PMC4616410 DOI: 10.1097/md.0000000000000850] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED The aim of this study was to assess the performance of the ETView VivaSight SL (ETView) single-lumen airway tube with an integrated high-resolution imaging camera in a manikin-simulated cardiopulmonary resuscitation scenario with and without chest compression. This was a randomized crossover manikin trial. Following a brief training session, 107 volunteer novice physicians who were inexperienced with airway management attempted to intubate a manikin using a Macintosh laryngoscope (MAC) and an ETView, with and without chest compressions. The participants were instructed to make 3 attempts in each scenario. In this trial, we compared intubation time, intubation success rates, and glottic visibility using a Cormack & Lehane Grade. Dental compression and ease of use of each device were also assessed. Median intubation times for the ETView and MAC without chest compressions were 17 (IQR, 15-19) s and 27 (IQR, 25-33) s, respectively (P < 0.001). The ETView proved more successful on the first intubation attempt than the MAC, regardless of compressions. Continuation of compressions caused an increase in intubation times for both the ETView (P = 0.27) and the MAC (P < 0.005). The ETView VivaSight SL is an effective tool for endotracheal intubation when used by novice physicians in a manikin-simulated cardiac arrest, both with and without chest compressions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02295618.
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Affiliation(s)
- Andrzej Kurowski
- From the Department of Anesthesiology and Critical Care, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland (AK); Department of Anesthesiology and Critical Care, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland and Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland (LS); Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland (ZT) and Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland and Department of Nephrologic Nursing, Medical University of Warsaw, Medical University of Warsaw, Warsaw, Poland (LC)
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Videolaryngoscopy at cardiac arrest – The need to move from video-games to video-science. Resuscitation 2015; 89:A7-9. [DOI: 10.1016/j.resuscitation.2015.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
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Szarpak Ł, Czyżewski Ł, Kurowski A, Truszewski Z. Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial. Eur J Pediatr 2015; 174:1325-32. [PMID: 25894914 PMCID: PMC4575358 DOI: 10.1007/s00431-015-2538-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED The aim of the present study was to evaluate whether the TruView video laryngoscope (TruView) facilitates pediatric endotracheal intubation (ETI) more quickly and safely than conventional Macintosh laryngoscope (MAC) in three manikin-based airway scenarios. This was a randomized crossover manikin study including 120 novice paramedics. The participants performed tracheal intubations using both TruView and MAC on a pediatric manikin in a control scenario (A), chest compression scenario (B), and chest compression cervical stabilization scenario (C). The sequence of scenarios was randomized. The primary outcome was time to intubation. Secondary outcomes were overall success rates, incidence of dental trauma, and ease of intubation. All intubation attempts were assessed by a trained assistant. The overall success rate was significantly higher with the TruView compared than the MAC in scenario B (100 vs. 81.7 %; p = 0.011) and scenario C (100 vs. 68.3 %; p < 0.001). The intubation time was significantly lower with the TruView than the MAC (18.5 vs. 24.3 s, p = 0.017, for scenario A; 21.6 vs. 25.7 s, p = 0.023, for scenario B; and 28.9 vs. 45.4 s, p < 0.001, for scenario C). Glottic view quality was better with TruView than the MAC in all scenarios, p < 0.001. CONCLUSIONS The TruView offers better intubation conditions than the MAC on a pediatric manikin in the control scenario, chest compression scenario, and chest compression scenario with cervical stabilization scenario. The TruView may be used to elevate the epiglottis for orotracheal intubation. Further clinical studies are necessary to confirm these initial positive findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02289872. WHAT IS KNOWN •Prehospital pediatric intubation using a standard laryngoscope is varied and ranges from 63.4 to 82 %. What is New: •This is the first study showing efficiency of pediatric endotracheal intubation using the TruView PCD by paramedics in tree simulation scenarios. •TruView PCD offers better pediatric intubation conditions than the Macintosh laryngoscope.
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Affiliation(s)
- Łukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Street 02-005, Warsaw, Poland.
| | - Łukasz Czyżewski
- Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland
- Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kurowski
- Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland
| | - Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Street 02-005, Warsaw, Poland
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