1
|
Maurya I, Ahmed SM, Garg R. Simulation in airway management teaching and training. Indian J Anaesth 2024; 68:52-57. [PMID: 38406347 PMCID: PMC10893796 DOI: 10.4103/ija.ija_1234_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024] Open
Abstract
There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.
Collapse
Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Kalyan Singh Super Specialty Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Syed M. Ahmed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
2
|
Bhakta P, Karim HMR, Mandal M, O'Brien B. Comparing devices for managing the difficult airway. Can J Anaesth 2024; 71:154-155. [PMID: 37919625 DOI: 10.1007/s12630-023-02626-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Pradipta Bhakta
- Department of Anesthesiology, Hull University Teaching Hospital NHS Trust, Hull, East Yorkshire, UK.
| | - Habib Md Reazaul Karim
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mohanchandra Mandal
- Department of Anaesthesiology and Intensive Care, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Brian O'Brien
- Department of Anaesthesiology and Intensive Care, Cork University Hospital, Cork, Ireland
| |
Collapse
|
3
|
Gaszyński T, Gómez-Ríos MÁ, Serrano-Moraza A, Sastre JA, López T, Ratajczyk P. New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review. Healthcare (Basel) 2023; 11:2468. [PMID: 37761667 PMCID: PMC10650429 DOI: 10.3390/healthcare11182468] [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: 07/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.
Collapse
Affiliation(s)
- Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | - Manuel Ángel Gómez-Ríos
- Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain;
| | | | - José Alfonso Sastre
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Teresa López
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| |
Collapse
|
4
|
Petzoldt M, Grün C, Wünsch VA, Bauer M, Hardel TT, Grensemann J. Vie Scope® versus videolaryngoscopy in expected difficult airways: a randomized controlled trial. Can J Anaesth 2023; 70:1486-1494. [PMID: 37537324 PMCID: PMC10447594 DOI: 10.1007/s12630-023-02534-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE The management of patients with an anticipated difficult airway remains challenging. We evaluated laryngeal visualization with the recently introduced Vie Scope® as a straight blade laryngoscope consisting of an illuminated tube necessitating bougie-facilitated intubation vs Macintosh videolaryngoscopy. METHODS We conducted a prospective randomized controlled noninferiority trial. Patients undergoing elective ear, nose, and throat or oral and maxillofacial surgery with an anticipated difficult airway were randomized 1:1 to receive tracheal intubation with the Vie Scope or Macintosh videolaryngoscope (C-MAC®). The primary outcome measure was laryngeal visualization by the percentage of glottis opening (POGO) scale. Secondary outcome measures were the time to successful intubation (TTI) and first-attempt and overall success rates. RESULTS We included two sets of 29 patients in our analysis. For visualization, the Vie Scope was noninferior to videolaryngoscopy (VL) with mean (standard deviation [SD]) POGO scores of 71 (31)% vs 64 (30)% in the VL group [difference in means, 7 (8)%; 95% confidence interval, -9 to 23; P = 0.38]. Mean (SD) TTI was 125 (129) sec in the Vie Scope and 51 (36) sec in the VL group (difference in means, 75 sec; 95% confidence interval, 25 to 124; P = 0.005). The first-attempt and overall success rates were 22/29 (76%) and 27/29 (93%) in both groups. Two patients per group were switched to a different device. Four accidental esophageal intubations occurred in the Vie Scope group, these were presumably due to bougie misplacement. CONCLUSION Visualization with the Vie Scope was noninferior to VL in patients with an anticipated difficult airway, but TTI was longer in the Vie Scope group. STUDY REGISTRATION ClinicalTrials.gov (NCT05044416); registered 5 September 2021.
Collapse
Affiliation(s)
- Martin Petzoldt
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharina Grün
- Department of Intensive Care Medicine, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Viktor A Wünsch
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Bauer
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim T Hardel
- Department of Intensive Care Medicine, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| |
Collapse
|
5
|
Wieczorek P, Pruc M, Krajsman MJ, Wieczorek W, Cander B, Szarpak L, Navolokina A, Matuszewski M, Zyla M, Bragazzi NL, Smereka J. A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings. Expert Rev Med Devices 2023; 20:943-950. [PMID: 37668350 DOI: 10.1080/17434440.2023.2253142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel. RESEARCH DESIGN AND METHODS This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade laryngoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience. RESULTS The results of the study showed that in scenario-A, there were no significant differences in the first attempt success rate or endotracheal intubation time between VieScope and MAC. However, VieScope was associated with better visualization of the glottis. In scenarios B and C, VieScope was significantly more effective than MAC in terms of first-pass success rate, time to intubate, Cormack-Lehane grade, POGO score, and ease of endotracheal intubation. CONCLUSIONS Bébé VieScope may be useful for endotracheal intubation in pediatric patients, particularly in cases of tongue edema and ongoing chest compression, providing a higher first-pass success rate than conventional laryngoscopes.
Collapse
Affiliation(s)
- Pawel Wieczorek
- Pediatric Intensive Care Unit (PICU), John Paul II Upper Silesian Health Centre in Katowice, Katowice, Poland
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Maciej J Krajsman
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Wieczorek
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Basar Cander
- Department of Emergency Medicine, Bezmialem Vakif University, Fatih/Istanbul, Turkey
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, USA
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Alla Navolokina
- European School of Medicine, International European University, Kyiv, Ukraine
| | - Michal Matuszewski
- Department of Anaesthesiology and Intensive Therapy The Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Michal Zyla
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Nicola L Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Jacek Smereka
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
6
|
Gaszynski T, Michalek P, Ratajczyk P. A Prospective Comparative Study of Laryngeal Glottic View Using the Vie Scope ® versus Standard Macintosh Laryngoscope in Morbidly Obese Patients. Ther Clin Risk Manag 2023; 19:405-411. [PMID: 37214351 PMCID: PMC10199711 DOI: 10.2147/tcrm.s377585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Background The visualization of the glottis may be inadequate in morbidly obese patients when a standard Macintosh blade laryngoscope (MCL) is used. The Vie Scope® (VS) is a novel type laryngoscope consisting of a straight, enclosed, illuminated tube that offers intubation via a bougie using the paraglossal technique. In this prospective, nonrandomized comparative study, we tested the research hypothesis that the VS may improve visualization of the glottic larynx in comparison to the MCL. Materials and Methods After obtaining institutional ethics committee approval, 60 morbidly obese patients (BMI >40 kg/m2) undergoing elective non-head and neck surgery were included in the study. After induction of general anesthesia (GA), the glottic visualization was performed using the two laryngoscopes in succession, first MCL size 3 or 4 followed by the VS and was assessed using the modified Cormack-Lehane scale. Tracheal intubation was performed using the VS The first pass intubation success and the total success rate was recorded only for the VS Intubation time was not measured because of the paired study design. Results and Discussion Mean demographic data included: age 41.9±8.2 years, height 171.2±10.2 cm, weight 129.9±21.6 kg, BMI 44.95±3.85 kg/m2. Using MCL, Cormack-Lehane grade 1 was observed in 36 (60%) cases; grade 2 in 7/60 (11.6%); grade 3 in 13/60 (21.7%); and grade 4 in 4/60 (6.7%). Poor laryngeal views represented by grades 3 and 4 were observed in 28.4% of patients with the MCL. Grades obtained with the VS were all grade 1 (100%). The first attempt intubation success was in 58/60 (96.7%) with the VS. No complications were observed. Conclusion The Vie Scope® laryngoscope, using the paraglossal technique of tracheal intubation, significantly improves visualization of the vocal cords in morbidly obese patients compared to the standard Macintosh laryngoscope.
Collapse
Affiliation(s)
- Tomasz Gaszynski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
7
|
Vasconcelos Pereira A, Simões AV, Rego L, Pereira JG. New technologies in airway management: A review. Medicine (Baltimore) 2022; 101:e32084. [PMID: 36482552 PMCID: PMC9726337 DOI: 10.1097/md.0000000000032084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The evolution of medical knowledge and technological growth have contributed to the development of different techniques and devices for airway management. These appear to play a role in optimizing the number of attempts and overall success, ultimately reducing the negative consequences of airway manipulation. In this literature review, we highlight the recent evidence regarding new technologies applied to airway management. Before intubation, every patient should have an individualized structured airway management plan. Technology can help with both airway evaluation and tracheal intubation. Point-of-care cervical ultrasound and artificial intelligence models with automated facial analysis have been used to predict difficult airways. Various devices can be used in airway management. This includes a robotic video endoscope that guides intubation based on real image recognition, a laryngeal mask with a non-inflatable cuff that tries to reduce local complications, video laryngeal masks that are able to confirm the correct position and facilitate intubation, Viescope™, a videolaryngoscope developed for combat medicine with a unique circular blade, a system that uses cervical transillumination for glottis identification in difficult airways and Vivasight SL™ tracheal tube, which has a high-resolution camera at its tip guaranteeing visual assurance of tube position as well as guiding bronchial blocker position. To conclude, we detailed the challenges in airway management outside the operating room as well as described suction-assisted laryngoscopy and airway decontamination technique for contaminated airways. Further research in the clinical setting is recommended to better support the use of these technologies.
Collapse
Affiliation(s)
- Ana Vasconcelos Pereira
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
- * Correspondence: Ana Vasconcelos Pereira, Department of Anesthesiology, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa Nº 2, Povos 2600-009 - Vila Franca DE Xira, Portugal (e-mail: )
| | - André Vicente Simões
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - Luísa Rego
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - João Gonçalves Pereira
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| |
Collapse
|
8
|
A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111774. [PMID: 36421223 PMCID: PMC9689205 DOI: 10.3390/children9111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p < 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p < 0.001). On the Cormack−Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.
Collapse
|
9
|
Airway Management during Massive Gastric Regurgitation Using VieScope or Macintosh Laryngoscope-A Randomized, Controlled Simulation Trial. J Clin Med 2022; 11:jcm11185363. [PMID: 36143008 PMCID: PMC9503399 DOI: 10.3390/jcm11185363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
In this model of massive gastric aspiration, we compared two different laryngoscopes (VieScope and Macintosh) in a randomized, controlled simulation study. The primary endpoint was time to intubation; the secondary endpoints were intubation success (i.e., tracheal tube position) and amount of pulmonary aspiration. Thirty-four anesthetists performed endotracheal intubation using VieScope and Macintosh laryngoscopy in a randomized order on an airway manikin simulating massive regurgitation of gastric fluid. The primary endpoint “time until intubation” could be achieved significantly faster (mean −12.4 s [95% confidence intervals (CI) −19.7 s; −7.3 s]) with Macintosh compared to VieScope (p < 0.001). Concerning “correct tube position”, no statistical difference was found between the devices (p = 1.0). The mean time to first ventilation was −11.1 s [95% CI −18.3 s; −5.3 s] when using Macintosh (p = 0.001). The mean volume of aspirated gastric fluid was lower in the Macintosh group: −90.0 mL [95% CI −235.0 mL; −27.5 mL] (p = 0.011). Data from this simulation study suggest that in a model of massive gastric regurgitation, airway management can be achieved faster and with less gastric aspiration when using a Macintosh laryngoscope compared to a VieScope laryngoscope.
Collapse
|
10
|
Petzoldt M, Engels Y, Popal Z, Tariparast PA, Sasu PB, Brockmann A, Punke MA, Grensemann J. Elective Tracheal Intubation With the VieScope-A Prospective Randomized Non-inferiority Pilot Study (VieScOP-Trial). Front Med (Lausanne) 2022; 9:820847. [PMID: 35372419 PMCID: PMC8964792 DOI: 10.3389/fmed.2022.820847] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tracheal intubation is commonly performed after direct laryngoscopy using Macintosh laryngoscopes (MacL), but visualization of the larynx may be inadequate. The VieScope (VSC) as a new type of laryngoscope consisting of a straight, shielded, illuminated tube used to perform intubation via a bougie was investigated in this prospective randomized trial in patients without expected difficult airways. Methods With ethics approval, 2 × 29 patients for elective surgery were randomized 1:1 to intubation with VSC or MacL. Endpoints were first attempt success rates (FAS), Percentage of Glottis Opening Scale (POGO), time to intubation (TTI), and difficulty ratings on visual analog scales (0–100, lower values better). Data are given as mean ± standard deviation. Results The FAS was 83 ± 38% for VSC and 86 ± 34% for MacL (P = 0.723). For VSC, POGO was 86 ± 17% and for MacL 68 ± 30% (P = 0.007). TTI for VSC was 93 ± 67s vs. 38 ± 17 for MacL (P < 0.001). Difficulty of intubation was rated 23 ± 22 for VSC vs. 18 ± 22 for MacL (P = 0.422), viewing conditions 12 ± 15 vs. 24 ± 25 (P = 0.031), and difficulty of tube placement was rated 27 ± 30 vs. 7 ± 8 (P = 0.001). Conclusion No difference in FAS was detected between VSC and MacL. Visualization of the larynx was superior using the VSC, while TTI was prolonged and tube placement via bougie was more challenging. The VSC could be an alternative to MacL in patients with difficult laryngoscopy, but this should be investigated further in patients with expected difficult airways.
Collapse
Affiliation(s)
- Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yasmin Engels
- Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zohal Popal
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pischtaz A Tariparast
- Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip B Sasu
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrés Brockmann
- Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark A Punke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Szarpak L, Peacock FW, Rafique Z, Ladny JR, Nadolny K, Malysz M, Dabrowski M, Chirico F, Smereka J. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med 2022; 53:122-126. [PMID: 35016094 PMCID: PMC8731221 DOI: 10.1016/j.ajem.2021.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). Methods Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. Results We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43–92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of −48 s (95%CI confidence interval [CI], −60.23, −35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). Conclusions The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. Trial registration: ClinicalTrials registration number NCT04365608
Collapse
Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland; Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jerzy R Ladny
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department Emergency Medicine, University Medicine of Białystok, Bialystok, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland
| | - Marek Malysz
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marek Dabrowski
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy; Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy
| | - Jacek Smereka
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
12
|
Ecker H, Kolvenbach S, Stranz S, Herff H, Wetsch WA. Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario - a randomized, controlled simulation trial. BMC Emerg Med 2021; 21:90. [PMID: 34330219 PMCID: PMC8323300 DOI: 10.1186/s12873-021-00484-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Endotracheal intubation continues to be the gold standard for securing the airway in emergency situations. Difficult intubation is still a dreadful situation when securing the airway. Objective To compare VieScope with Glidescope and conventional Macintosh laryngoscopy (MAC) in a simulated difficult airway situation. Methods In this randomized controlled simulation trial, 35 anesthesiologists performed endotracheal intubation using VieScope, GlideScope and MAC in a randomized order on a certified airway manikin with difficult airway. Results For the primary endpoint of correct tube position, no statistical difference was found (p = 0.137). Time until intubation for GlideScope (27.5 ± 20.3 s) and MAC (20.8 ± 8.1 s) were shorter compared to the VieScope (36.3 ± 10.1 s). Time to first ventilation, GlideScope (39.3 ± 21.6 s) and MAC (31.9 ± 9.5 s) were also shorter compared to the VieScope (46.5 ± 12.4 s). There was no difference shown between handling time for VieScope (20.7 ± 7.0 s) and time until intubation with GlideScope or MAC. Participants stated a better Cormack & Lehane Score with VieScope, compared to direct laryngoscopy. Conclusion Rate of correct tracheal tube position was comparable between the three devices. Time to intubation and ventilation were shorter with MAC and Glidescope compared to VieScope. It did however show a comparable handling time to video laryngoscopy and MAC. It also did show a better visualization of the airway in the Cormack & Lehane Score compared to MAC. Trial registration The study was registered at the German Clinical Trials Register www.drks.de (Identifier: DRKS00024968) on March 31st 2021.
Collapse
Affiliation(s)
- Hannes Ecker
- University of Cologne, Medical Faculty, and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937, Cologne, Germany
| | - Simone Kolvenbach
- University of Cologne, Medical Faculty, and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sebastian Stranz
- University of Cologne, Medical Faculty, and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937, Cologne, Germany
| | - Holger Herff
- University of Cologne, Medical Faculty, and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- University of Cologne, Medical Faculty, and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937, Cologne, Germany.
| |
Collapse
|