Purpose. In resuscitation, chest compression is essential, and it should be performed appropriately and uninterruptedly to obtain the return of spontaneous circulation and breathing. However, attempt of tracheal intubation with the Macintosh laryngoscope (Mac) occasionally needs a temporary pause of chest compression and delays its resuming. Consequently, we studied the efficacy of the new video-laryngoscopes, PENTAX-AWS (AWS) and Airtraq (ATQ) as device used for tracheal intubation while nonstop chest compression.
Materials and Methods. Twenty seven participants including 11 non-anesthetic doctors, 1 paramedic, 11 nurses and 4 medical students enrolled in this study. At first, Participants and supplementary assistant who concentrated on chest compression simulated CPR with the use of Resusci Anne Simulator manikin (Laerdal) placed on medical emergency bed as 30:2 protocol proposed in 2005 AHA Guidelines. Strength and rhythm of the compression were monitored in real-time by PC skill-reporting system. After the chest compressions became constant, participants were requested to intubate with using Mac, AWS and ATQ in both situations without chest compression and while the compression.
Results. Tracheal intubation was successfully achieved within 3 attempts by 92.6% participants in Mac and 100% in AWS and ATQ without chest compression, and 66.7% in Mac, 100% in AWS and 81.5% in ATQ while chest compression. Rate of success in the 1st attempt was 55.6% in Mac, 96.3% in AWS and 51.9% in ATQ while compression. Time to intubate while compression with AWS was 14.6s, which was significantly shorter than 26.1s with ATQ in the successful attempts.
Conclusions. With using AWS, high success rate of tracheal intubation was achieved even in chest compression situation in comparison with the other two devices. Macintosh laryngoscope is the most inconvenient among these devices when tracheal intubation is attempted while chest compression. ATQ showed significant decrease of success rate in compression situation despite it achieved 100% success without compression. PENTAX-AWS is expected to be more useful than Macintosh laryngoscope and Airtraq to establish tracheal intubation while uninterrupted chest compression in clinical use.
Tracheal intubation during chest compressions using Pentax-AWS®, GlideScope®, and Macintosh laryngoscope: a randomized crossover trial using a mannequin
