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Choi J, Lee Y, Kang GH, Jang YS, Kim W, Choi HY, Kim JG. Educational suitability of new channel-type video-laryngoscope with AI-based glottis guidance system for novices wearing personal-protective-equipment. Medicine (Baltimore) 2022; 101:e28890. [PMID: 35244042 PMCID: PMC8896493 DOI: 10.1097/md.0000000000028890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/04/2022] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to determine which of 4 laryngoscopes, including A-LRYNGO, a newly developed channel-type video-laryngoscope with an embedded artificial intelligence-based glottis guidance system, is appropriate for tracheal intubation training in novice medical students wearing personal protective equipment (PPE).Thirty healthy senior medical school student volunteers were recruited. The participants underwent 2 tests with 4 laryngoscopes: Macintosh, McGrath, Pentax Airway-Scope and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshop. The second test was conducted after a one-on-one hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc, and asked all participants to complete a short questionnaire.The time to completely insert the endotracheal tube with the Macintosh laryngoscope did not change significantly (P = .177), but the remaining outcomes significantly improved after the hands-on workshop (all P < .05). Despite being novice practitioners with no intubation experience and wearing PPE, the, 2 channel-type video-laryngoscopes were associated with good intubation-related performance before the hands-on workshop (all P < .001). A-LRYNGO's artificial intelligence-based glottis guidance system showed 93.1% accuracy, but 20.7% of trials were guided by the vocal folds.To prepare to manage the airway of critically ill patients during the coronavirus disease 2019 pandemic, a channel-type video-laryngoscope is appropriate for tracheal intubation training for novice practitioners wearing PPE.
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Affiliation(s)
- Jaesoon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Yoonje Lee
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Hyun Young Choi
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
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Foley LJ, Urdaneta F, Berkow L, Aziz MF, Baker PA, Jagannathan N, Rosenblatt W, Straker TM, Wong DT, Hagberg CA. Difficult Airway Management in Adult COVID-19 Patients: Statement by the Society of Airway Management. Anesth Analg 2021; 133:876-890. [PMID: 33711004 DOI: 10.1213/ane.0000000000005554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 disease, caused by Coronavirus SARS-CoV-2, often results in severe hypoxemia requiring airway management. Because SARS CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue the Society for Airway Management (SAM) created a task force to review existing literature and current Practice Guidelines for management of the difficult airway by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. SAM task force created recommendations for management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of AGREE Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. and difficult airway management often takes longer, may involve multiple procedures with aerosolization potential, strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When patient's airway risk assessment suggests awake tracheal intubation is an appropriate choice of technique, procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with tight seal facemask may be performed to reduce risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as first-line strategy for airway management. If emergent invasive airway access is indicated, we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.
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Affiliation(s)
- Lorraine J Foley
- Department of Anesthesiology, Winchester Hospital of Beth Israel Lahey Health, Tufts School of Medicine, Boston, MA, USA
| | - Felipe Urdaneta
- Department of Anesthesiology, University of Florida NFSGVHS, Gainesville FL, USA
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael F Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Narasimhan Jagannathan
- Department of Anesthesiology Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine Chicago, IL
| | - William Rosenblatt
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Tracey M Straker
- Department of Anesthesiology, Montefiore Hospital, Albert Einstein College of Medicine New York, NY, USA
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abola RE, Schwartz JA, Forrester JD, Gan TJ. A Practical Guide for Anesthesia Providers on the Management of Coronavirus Disease 2019 Patients in the Acute Care Hospital. Anesth Analg 2021; 132:594-604. [PMID: 33122542 DOI: 10.1213/ane.0000000000005295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has infected millions of individuals and posed unprecedented challenges to health care systems. Acute care hospitals have been forced to expand hospital and intensive care capacity and deal with shortages in personal protective equipment. This guide will review 2 areas where the anesthesiologists will be caring for COVID-19 patients: the operating room and on airway teams. General principles for COVID-19 preparation and hospital procedures will be reviewed to serve as a resource for anesthesia departments to manage COVID-19 or future pandemics.
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Affiliation(s)
- Ramon E Abola
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | - Jonathan A Schwartz
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | | | - Tong J Gan
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
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Laack TA, Pollok F, Sandefur BJ, Mullan AF, Russi CS, Yalamuri SM. Barrier Enclosure for Endotracheal Intubation in a Simulated COVID-19 Scenario: A Crossover Study. West J Emerg Med 2020; 21:1080-1083. [PMID: 32970558 PMCID: PMC7514393 DOI: 10.5811/westjem.2020.7.48574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Barrier enclosures have been developed to reduce the risk of COVID-19 transmission to healthcare providers during intubation, but little is known about their impact on procedure performance. We sought to determine whether a barrier enclosure delays time to successful intubation by experienced airway operators. Methods We conducted a crossover simulation study at a tertiary academic hospital. Participants watched a four-minute video, practiced one simulated intubation with a barrier enclosure, and then completed one intubation with and one without the barrier enclosure (randomized to determine order). The primary outcome measure was time from placement of the video laryngoscope at the lips to first delivered ventilation. Secondary outcomes were periprocedural complications and participant responses to a post-study survey. Results Proceduralists (n = 50) from emergency medicine and anesthesiology had median intubation times of 23.6 seconds with practice barrier enclosure, 20.5 seconds with barrier enclosure, and 16.7 seconds with no barrier. Intubation with barrier enclosure averaged 4.5 seconds longer (95% confidence interval, 2.7–6.4, p < .001) than without, but was less than the predetermined clinical significance threshold of 10 seconds. Three complications occurred, all during the practice intubation. Barrier enclosure made intubation more challenging according to 48%, but 90% indicated they would consider using it in clinical practice. Conclusion Experienced airway operators performed intubation using a barrier enclosure with minimal increased time to procedure completion in this uncomplicated airway model. Given potential to reduce droplet spread, use of a barrier enclosure may be an acceptable adjunct to endotracheal intubation for those familiar with its use.
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Affiliation(s)
- Torrey A Laack
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.,Mayo Clinic, Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota
| | - Franziska Pollok
- Mayo Clinic, Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota
| | | | - Aidan F Mullan
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota
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Personal protective equipment, airway management, and systematic reviews. Comment on Br J Anaesth 2020; 125: e301-5. Br J Anaesth 2020; 125:e360-e361. [PMID: 32654744 PMCID: PMC7324337 DOI: 10.1016/j.bja.2020.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022] Open
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Sanfilippo F, Tigano S, Palumbo GJ, Astuto M, Murabito P. Systematic review of simulated airway management whilst wearing personal protective equipment. Br J Anaesth 2020; 125:e301-e305. [PMID: 32624187 PMCID: PMC7293489 DOI: 10.1016/j.bja.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023] Open
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Kuza CM, McIsaac JH. Emergency Preparedness and Mass Casualty Considerations for Anesthesiologists. Adv Anesth 2018; 36:39-66. [PMID: 30414641 PMCID: PMC7127691 DOI: 10.1016/j.aan.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Catherine M Kuza
- Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of USC, 1520 San Pablo Street, Suite 3451, Los Angeles, CA 90033, USA.
| | - Joseph H McIsaac
- Department of Biomedical Engineering, University of Connecticut (UConn) Medical Center, 263 Farmington Avenue, Farmington, CT 06032, USA
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Kwon MY, Kim GH, Kim B, Koo MS. The experience of endotracheal intubation in Middle East respiratory syndrome patients -A case report-. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mi-Young Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Gunn Hee Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Byunguk Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Min Seok Koo
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
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Claret PG, Asencio R, Rogier D, Roger C, Fournier P, Tran TA, Sebbane M, Bobbia X, Emmanuel de La Coussaye J. Comparison of Miller and Airtraq laryngoscopes for orotracheal intubation by physicians wearing CBRN protective equipment during infant resuscitation: a randomized crossover simulation study. Scand J Trauma Resusc Emerg Med 2016; 24:35. [PMID: 27004945 PMCID: PMC4804507 DOI: 10.1186/s13049-016-0228-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the performance of orotracheal intubation with the Miller laryngoscope compared with the Airtraq laryngoscope by emergency and pediatric physicians wearing CBRN-PPE type III on infant manikins with conventional airway. We hypothesized that in this situation, the orotracheal intubation with the Airtraq laryngoscope would be faster and more effective than with the Miller laryngoscope. METHODS This was a prospective, randomized, crossover, single-center study who recruited emergency department physicians on a voluntary basis. Each physician performed a total of 20 intubation trials while in CBRN-PPE with the two intubation techniques, Miller and Airtraq. Intubations by each airway device were tested over ten consecutive runs. The order of use of one or the other devices was randomized with a ratio of 1:1. The primary endpoint was overall orotracheal intubation success. RESULTS Fifty-five emergency and pediatric physicians were assessed for eligibility. Forty-one physicians were included in this study and 820 orotracheal intubation attempts were performed. The orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller (99% vs. 92%; p-adjusted <.001). The orotracheal intubation and glottis visualization times decreased with the number of attempts (p <.001). The median orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope (15 s vs. 20 s; p-adjusted <.001). The median glottis visualization time with the Airtraq laryngoscope and with the Miller laryngoscope were not different (6.0 s vs. 7.5 s; p-adjusted =.237). Thirty-four (83 %) physicians preferred the Airtraq laryngoscope versus 6 (15 %) for the Miller (p-adjusted <.001). DISCUSSION For tracheal intubation by physicians wearing CBRN-PPE during infant resuscitation simulation, we showed that the orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller laryngoscope and that orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope. CONCLUSIONS It seems useful to train the physicians in emergency departments in the use of pediatric Airtraq and for the management of CBRN risks.
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Affiliation(s)
- Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France. .,EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France.
| | - Renaud Asencio
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Damien Rogier
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Claire Roger
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Philippe Fournier
- Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Tu-Anh Tran
- Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Mustapha Sebbane
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Xavier Bobbia
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
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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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Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study. Prehosp Disaster Med 2015; 30:259-63. [PMID: 25959708 DOI: 10.1017/s1049023x15004707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE. METHODS Post-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities. RESULTS Twenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario. CONCLUSION The time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.
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