Optimising tracheal intubation success rate using the Airtraq laryngoscope

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

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Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

BioMed Research International ◽

10.1155/2015/617805 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Nobuyasu Komasawa ◽

Akira Hyoda ◽

Sayuri Matsunami ◽

Nozomi Majima ◽

Toshiaki Minami

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Success Rate ◽

Difficult Airway Management ◽

Intubation Time ◽

Simulation Based ◽

Intubation Success ◽

Intubation Success Rate ◽

Crossover Analysis ◽

Airway Model

Background.Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods.Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time.Results.In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P=0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB.Conclusion.GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

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Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00863-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jürgen Knapp ◽

Bettina Eberle ◽

Michael Bernhard ◽

Lorenz Theiler ◽

Urs Pietsch ◽

...

Keyword(s):

Emergency Medicine ◽

Quality Control ◽

Tracheal Intubation ◽

Airway Management ◽

Success Rate ◽

Video Laryngoscope ◽

Solar Irradiation ◽

Video Laryngoscopy ◽

Trauma Patients ◽

Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

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Glidescope® videolaryngoscope improves intubation success rate in cardiac arrest scenarios without chest compressions interruption: A randomized cross-over manikin study

Resuscitation ◽

10.1016/j.resuscitation.2010.12.011 ◽

2011 ◽

Vol 82 (4) ◽

pp. 464-467 ◽

Cited By ~ 25

Author(s):

Theodoros Xanthos ◽

Konstantinos Stroumpoulis ◽

Eleni Bassiakou ◽

Eleni Koudouna ◽

Ioannis Pantazopoulos ◽

...

Keyword(s):

Cardiac Arrest ◽

Success Rate ◽

Chest Compressions ◽

Manikin Study ◽

Intubation Success ◽

Intubation Success Rate

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Nasal Probe Tests Decreased the Procedure Time During Flexible Bronchoscopy: A Randomized Controlled Trial

10.21203/rs.3.rs-105235/v1 ◽

2020 ◽

Author(s):

Wenjun Zhu ◽

Yuchen Zhang ◽

Jingyu Shi ◽

Xiaoqin Wang ◽

Renjiao Li ◽

...

Keyword(s):

Nasal Cavity ◽

Success Rate ◽

Controlled Trial ◽

Flexible Bronchoscopy ◽

Control Group ◽

Randomized Controlled ◽

Intubation Success ◽

First Pass ◽

Intubation Success Rate ◽

Nasal Bleeding

Abstract Background: Nasal insertion is the preferred method in flexible bronchoscopy; however, the relatively narrow nasal cavity increases the difficulty of bronchoscope insertion. The aim of the study was to investigate the advantages of a prior nasal cavity probe during flexible bronchoscopy and to investigate whether this novel method could reduce the complications associated with flexible bronchoscopy.Methods: This prospective randomized controlled trial was conducted in a tertiary hospital between May 2020 and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: a control group, a simple cotton bud detection group (CD group), and an adrenaline detection group (AD group). The outcomes were the time to pass the glottis, the first-pass intubation success rate, and postoperative complications, especially nasal bleeding.Results: In total, 189 men and 111 women were enrolled in the study, with a mean age of 55.69 ± 12.86 years. The operation time was longer in the control group (24 [14.25-45.75] s) than in the CD group (19.5 [12.25-32.75] s). Compared with that in the CD group, the first-pass intubation success rate was significantly lower in the control group (p<0.05). There was no difference in nasal bleeding between the control group and the CD group (p=0.506). Nasal bleeding after flexible bronchoscopy was more common in the CD group than in the AD group (p=0.005); however, there was no significant between-group difference in hemostatic use (p=0.245). Conclusions: Use of a prior nasal cavity probe during flexible bronchoscopy can significantly reduce the time to pass the nasal cavity, improve the first-pass intubation success rate, and reduce postoperative nasal bleeding. Nasal detection is recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. Trial registration: ChiCTR2000032668, 6th May.2020.

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Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope®

The Korean Journal of Critical Care Medicine ◽

10.4266/kjccm.2013.28.4.241 ◽

2013 ◽

Vol 28 (4) ◽

pp. 241

Author(s):

Hyung Seo Jang ◽

Jun Bum Park ◽

Jae Hoon Oh ◽

Chang Sun Kim ◽

Hyuk Joong Choi ◽

...

Keyword(s):

Success Rate ◽

Intubation Success ◽

Intubation Success Rate ◽

Exposure Methods

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Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation

JAMA ◽

10.1001/jama.2019.18254 ◽

2019 ◽

Vol 322 (23) ◽

pp. 2303 ◽

Cited By ~ 15

Author(s):

Bertrand Guihard ◽

Charlotte Chollet-Xémard ◽

Philippe Lakhnati ◽

Benoit Vivien ◽

Claire Broche ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Intubation Success ◽

Intubation Success Rate

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External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2012.01.010 ◽

2012 ◽

Vol 30 (9) ◽

pp. 2005-2010 ◽

Cited By ~ 4

Author(s):

Nir Samuel ◽

Karyn Winkler ◽

Shuny Peled ◽

Baruch Krauss ◽

Itai Shavit

Keyword(s):

Success Rate ◽

Manikin Study ◽

Intubation Success ◽

Intubation Success Rate

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First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000161 ◽

2015 ◽

Vol 22 (6) ◽

pp. 391-394 ◽

Cited By ~ 29

Author(s):

Joost Peters ◽

Bas van Wageningen ◽

Ilze Hendriks ◽

Ruud Eijk ◽

Michael Edwards ◽

...

Keyword(s):

Success Rate ◽

Rapid Sequence Induction ◽

Rapid Sequence ◽

Intubation Success ◽

First Pass ◽

Intubation Success Rate ◽

Sequence Induction

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Physician-staffed helicopter emergency medical services augment ground ambulance paediatric airway management in urban areas: a retrospective cohort study

Emergency Medicine Journal ◽

10.1136/emermed-2019-208421 ◽

2019 ◽

Vol 36 (11) ◽

pp. 678-683 ◽

Cited By ~ 2

Author(s):

Alan A Garner ◽

Nicholas Bennett ◽

Andrew Weatherall ◽

Anna Lee

Keyword(s):

Airway Management ◽

Emergency Medical Services ◽

Success Rate ◽

Urban Area ◽

Neuromuscular Blockade ◽

Urban Areas ◽

Large Urban Area ◽

Advanced Airway ◽

Intubation Success ◽

Intubation Success Rate

ObjectivesPaediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS.MethodsWe performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival.ResultsOverall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised.ConclusionsPS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.

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