Fiberoptic, Video Laryngoscope, and Nasal Airway Procedures

In patients with known or suspected difficult airways, advanced airway procedures such as fiberoptic laryngoscopy (under general anesthesia—with and without supraglottic airways—and sometimes in awake patients) as well as video laryngoscopy are invaluable. All may be particularly advantageous for use with patients who have limited or reduced cervical spine movement. Other advantages and disadvantages are addressed in this chapter. Techniques for nasotracheal intubation are also described. Flexible fiberoptic laryngoscopy is a means of indirectly visualizing airway structures by threading a fiberoptic scope with a camera at the end of the scope into the airway. The goal of fiberoptic laryngoscopy is endotracheal intubation using a Seldinger technique, whereby an endotracheal tube is guided into the trachea over the fiberoptic bronchoscope. Fiberoptic endotracheal intubation may be performed through the mouth or nose, or through a supraglottic airway (SGA). The use of the fiberoptic scope through an SGA is an especially useful technique in infants who suffer from airway obstruction at rest (e.g., infants with Pierre Robin syndrome). Video laryngoscopy employs a laryngoscope with a camera at the end of the blade to enable the user to indirectly visualize airway structures.

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Comparison of the Skill of Emergency Medical Technicians in Terms of Advanced Airway Management Using Endotracheal Tube vs Laryngeal Mask Airway in an OSCE Using a Mannequin

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i4.4632 ◽

2020 ◽

Author(s):

Peyman Saberian ◽

Ehsan Karimialavijeh ◽

Mostafa Sadeghi ◽

Mojgan Rahimi ◽

Parisa Hasani-Sharamin ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Airway Management ◽

Endotracheal Tube ◽

Endotracheal Intubation ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Emergency Medical ◽

Advanced Airway ◽

Significant Difference ◽

The Mean

Background: Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard. Methods: In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared. Results: Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427). Conclusion: In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

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Abstract 277: Supraglottic Airway Use Is Associated with Higher Chest Compression Fraction than Endotracheal Intubation During Out-of-Hospital Cardiopulmonary Arrest

Circulation ◽

10.1161/circ.130.suppl_2.277 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michael C Kurz ◽

David Prince ◽

J Christenson ◽

J Carlson ◽

S May ◽

...

Keyword(s):

Endotracheal Intubation ◽

Chest Compression ◽

Cardiopulmonary Arrest ◽

Supraglottic Airway ◽

P Value ◽

Advanced Airway ◽

Before And After ◽

Initial Rhythm ◽

Bystander Cpr ◽

Compression Data

Objective: Chest compression interruptions - such as those from endotracheal intubation (ETI) - are associated with poorer out-of hospital cardiac arrest (OHCA) survival. Select Emergency Medical Services (EMS) practitioners substitute ETI with supraglottic airway (SGA) insertion to minimize these interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult OHCA receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA and >2 minutes of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique and stratified these analyses by initial rhythm. We analyzed the data using t-tests and multivariable linear regression. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2,767 cases, including 2051 ETI, 671 SGA, and 45 both. Unadjusted pre- and post- airway CCF was higher for SGA than ETI (pre- 0.732 vs 0.706, difference -0.026 95% CI -0.044, -0.008; post- 0.767 vs 0.724, difference -0.043 95% CI -0.060, -0.026). Adjusted post-airway CCF improved with both techniques, but the changes were not statistically significant (0.012 difference, 95% CI 0.036, -0.012, p-value 0.32). CCF differences were similar when stratified by initial rhythm. Conclusion: In this series SGA insertion was associated with a higher CCF than ETI and that difference persisted post-airway insertion. Advanced airway management strategy may minimally impact CCF.

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Faculty Opinions recommendation of Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726299059.793528514 ◽

2017 ◽

Author(s):

Michael Aziz

Keyword(s):

Cardiopulmonary Resuscitation ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Randomized Controlled Study ◽

Video Laryngoscopy ◽

Controlled Study ◽

Randomized Controlled

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ENDOTRACHEAL INTUBATION VERSUS SUPRAGLOTTIC AIRWAY INSERTION IN CARDIAC ARREST: THE PREHOSPITAL EXPERIENCE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04604-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 3250

Author(s):

Aditya Shekhar ◽

Ira Blumen ◽

Jagat Narula

Keyword(s):

Cardiac Arrest ◽

Endotracheal Intubation ◽

Supraglottic Airway

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Comparison of the Bullard and Macintosh Laryngoscopes for Endotracheal Intubation of Patients with a Potential Cervical Spine Injury

Anesthesiology ◽

10.1097/00000542-199712000-00012 ◽

1997 ◽

Vol 87 (6) ◽

pp. 1335-1342 ◽

Cited By ~ 97

Author(s):

Andrew D. J. Watts ◽

Adrian W. Gelb ◽

David B. Bach ◽

David M. Pelz

Keyword(s):

Cervical Spine ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Cervical Spine Injury ◽

Cricoid Pressure ◽

Macintosh Laryngoscope ◽

Spine Injury ◽

Neck Extension ◽

Bullard Laryngoscope ◽

Spine Movement

Background In the emergency trauma situation, in-line stabilization (ILS) of the cervical spine is used to reduce head and neck extension during laryngoscopy. The Bullard laryngoscope may result in less cervical spine movement than the Macintosh laryngoscope. The aim of this study was to compare cervical spine extension (measured radiographically) and time to intubation with the Bullard and Macintosh laryngoscopes during a simulated emergency with cervical spine precautions taken. Methods Twenty-nine patients requiring general anesthesia and endotracheal intubation were studied. Patients were placed on a rigid board and anesthesia was induced. Laryngoscopy was performed on four occasions: with the Bullard and Macintosh laryngoscopes both with and without manual ILS. Cricoid pressure was applied with ILS. To determine cervical spine extension, radiographs were exposed before and during laryngoscopy. Times to intubation and grade view of the larynx were also compared. Results Cervical spine extension (occiput-C5) was greatest with the Macintosh laryngoscope (25.9 degrees +/- 2.8 degrees). Extension was reduced when using the Macintosh laryngoscope with ILS (12.9 +/- 2.1 degrees) and the Bullard laryngoscope without stabilization (12.6 +/- 1.8 degrees; P < 0.05). Times to intubation were similar for the Macintosh laryngoscope with ILS (20.3 +/- 12.8 s) and for the Bullard without ILS (25.6 +/- 10.4 s). Manual ILS with the Bullard laryngoscope results in further reduction in cervical spine extension (5.6 +/- 1.5 degrees) but prolongs time to intubation (40.3 +/- 19.5 s; P < 0.05). Conclusions Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.

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Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis

Resuscitation ◽

10.1016/j.resuscitation.2015.05.007 ◽

2015 ◽

Vol 93 ◽

pp. 20-26 ◽

Cited By ~ 83

Author(s):

Justin L. Benoit ◽

Ryan B. Gerecht ◽

Michael T. Steuerwald ◽

Jason T. McMullan

Keyword(s):

Cardiac Arrest ◽

Endotracheal Intubation ◽

Meta Analysis ◽

Supraglottic Airway ◽

Hospital Cardiac Arrest

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Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

British Paramedic Journal ◽

10.29045/14784726.2021.12.6.3.24 ◽

2021 ◽

Vol 6 (3) ◽

pp. 24-30

Author(s):

Amani Alenazi ◽

Bashayr Alotaibi ◽

Najla Saleh ◽

Abdullah Alshibani ◽

Meshal Alharbi ◽

...

Keyword(s):

Saudi Arabia ◽

Airway Management ◽

Success Rate ◽

Phase 1 ◽

Adult Patients ◽

Supraglottic Airway ◽

Future Research ◽

Phase 2 ◽

Advanced Airway ◽

Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

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