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Evrin T, Dabkowski M, Pruc M, Hernik J, Wieczorek W, Chabowski L, Wieczorek P, Chmielewski J, Feduniw S, Szarpak L. ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study. J Clin Med 2023; 12:5074. [PMID: 37568476 PMCID: PMC10419956 DOI: 10.3390/jcm12155074] [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: 07/04/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.
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Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, Medical Faculty, Ufuk University, 06510 Ankara, Turkey
| | - Miroslaw Dabkowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, International Academy of Ecology and Medicine, 02000 Kyiv, Ukraine
| | - Jacek Hernik
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
| | - Wojciech Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Warsaw, 02-013 Warsaw, Poland
| | - Lukasz Chabowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, Odessa International Medical University, 12042 Odessa, Ukraine
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Pediatric Intensive Care Unit (PICU), John Paul II Upper Silesian Health Centre in Katowice, 40-752 Katowice, Poland
| | - Jaroslaw Chmielewski
- Institute of Environmental Protection—National Research Institute (IEP-NRI), 02-170 Warsaw, Poland
- Department of Public Health, International European University, 03187 Kyiv, Ukraine
| | - Stepan Feduniw
- Department of Obstetrics, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
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Kluj P, Fedorczak A, Fedorczak M, Gaszyński T, Kułak C, Wasilewski M, Znyk M, Bartczak M, Ratajczyk P. Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial. Healthcare (Basel) 2023; 11:healthcare11060884. [PMID: 36981541 PMCID: PMC10048466 DOI: 10.3390/healthcare11060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-viewTM VL, UESCOPE® VL, ProVu® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. Results: The longest IT was noted when the UESCOPE® (29.4 s) and ProVu® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu®, UESCOPE® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE® and ProVu®. Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE® and ProVu® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.
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Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
- Correspondence:
| | - Anna Fedorczak
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Cezary Kułak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Mikołaj Wasilewski
- Clinic of Anesthesiology and Intensive Therapy, Medical University of Lodz, 92-213 Lodz, Poland
| | - Mateusz Znyk
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Maria Bartczak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
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Kim DS, Jeong D, Park JE, Lee GT, Shin TG, Chang H, Kim T, Lee SU, Yoon H, Cha WC, Sim YJ, Park SY, Hwang SY. Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment. J Pers Med 2022; 12:jpm12101720. [PMID: 36294859 PMCID: PMC9605128 DOI: 10.3390/jpm12101720] [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: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
This study sought to determine whether the C-MAC video laryngoscope (VL) performed better than a direct laryngoscope (DL) when attempting endotracheal intubation (ETI) in the emergency department (ED) while wearing personal protective equipment (PPE). This was a retrospective single-center observational study conducted in an academic ED between February 2020 and March 2022. All emergency medical personnel who participated in any ETI procedure were required to wear PPE. The patients were divided into the C-MAC VL group and the DL group based on the device used during the first ETI attempt. The primary outcome measure was the first-pass success (FPS) rate. A multiple logistic regression was used to determine the factors associated with FPS. Of the 756 eligible patients, 650 were assigned to the C-MAC group and 106 to the DL group. The overall FPS rate was 83.5% (n = 631/756). The C-MAC group had a significantly higher FPS rate than the DL group (85.7% vs. 69.8%, p < 0.001). In the multivariable logistic regression analysis, C-MAC use was significantly associated with an increased FPS rate (adjusted odds ratio, 2.86; 95% confidence interval, 1.69−4.08; p < 0.001). In this study, we found that the FPS rate of ETI was significantly higher when the C-MAC VL was used than when a DL was used by emergency physicians constrained by cumbersome PPE.
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Affiliation(s)
- Da Saem Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul 06351, Korea
| | - Yong Jin Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-2053
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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
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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
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