Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial

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.

[Video-Assisted Psychotherapy For Refugees: A Pilot Study]

OBJECTIVE

Global conflicts and humanitarian crises led to an increase in forced migration to Germany in recent years. To improve the mental health care system for refugees and asylum seekers in Germany perspectively, we aim to examine the feasibility of implementing the culturally sensitive group psychotherapy Empowerment for refugees with affective disorders in a video-assisted setting.

METHODS

Empowerment is a culturally sensitive, interpreter-assisted intervention for the treatment of depressive and stress-related symptoms in refugees. Four male refugees from Afghanistan participated in a pilot study. The intervention included 16 modules delivered via video over a 12-week period.

RESULTS

The internet connection was frequently unstable and led to organizational challenges. The therapy was feasible in terms of linguistic and interactional aspects.

DISCUSSION

The stability of the internet connection represents the major criterion for a successful implementation of the therapy. Implications for future studies are discussed.

CONCLUSION

Regarding the potential opportunities to improve the mental health care provision to refugees and asylum seekers in the future, the video-assisted therapy concept could be investigated in a randomized controlled trial.

H - 19 "Clinical Validation of a Video- Based Instrument to Assess Social Cognition: INEVICS"

OBJECTIVE

Autism Spectrum Disorder (ADS), are characterized by the lack of social cognition (SC). The evaluation instrument used in this study has the purpose of contributing as an evaluation method directly to the various components of S.C. and demonstrating the possible clinical and discriminatory validity of this audiovisual instrument in the Puerto Rican (P.R.) population with ASD.

METHODS

Exploratory quantitative approach was implemented. This pilot project used 9 videos to assess components of SC, administered virtually. Correction: sum of the results of all the videos, max.81 points. The population selected based on availability: participants with a diagnosis of ASD level one (clinical group) and participants with neurotypical development (control group). Groups were constituted of P.R. males and females between the ages of 8 to 12 years.

RESULTS

A total of forty-one participated (n = 41). significant difference component: Theory of mind: control group (x-=12.1, SD = 2.84), (x-=14.74, SD = 2.1) clinical group (x-=7.65, SD = 3.07), (x-=10.6, SD = 2.95), t (39) = 4.82 = P < 0.0000 and t (39) = 5.19 = P < 0.0000. Significant difference: S.C.: control group: (x-=56.83, SD = 8.11) clinical group: (x-=40.7, SD = 10), t (39) = 5.68 = P < 0.0000. Discriminant validity video 1: least (0.343) video 3: highest (0.716). Internal consistency: (α = 0.86).

CONCLUSIONS

INEVICS discriminated against difficulties with S.C. in participants with ASD. The theory of mind component was the most captured. The evaluation of social cognition cannot be dependent on a single social situation but rather requires the identification of the different components in different social situations.