scholarly journals Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Togay Evrin ◽  
Jacek Smereka ◽  
Damian Gorczyca ◽  
Szymon Bialka ◽  
Jerzy Robert Ladny ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Chest Compression ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Difficult Airways

Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

scholarly journals Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Ryosuke Mihara ◽  
Nobuyasu Komasawa ◽  
Sayuri Matsunami ◽  
Toshiaki Minami
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Direct Laryngoscope ◽  
Mcgrath Mac ◽  
Significant Difference ◽  
Intubation Success ◽  
Intubation Success Rate

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.

scholarly journals Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Sanghyun Lee ◽  
Wonhee Kim ◽  
Hyunggoo Kang ◽  
Jaehoon Oh ◽  
Tae Ho Lim ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Lateral Tilt ◽  
Glottic View ◽  
Advanced Airway ◽  
Significant Difference ◽  
Maternal Cardiopulmonary Resuscitation

Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt.Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation.Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (allP<0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt,P=1; in 30° tilt,P=0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (allP<0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes.Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
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.

scholarly journals Should the Glidescope video laryngoscope be used first line for all oral intubations or only in those with a difficult airway? A review of current literature

2018 ◽  
Vol 28 (12) ◽  
pp. 322-333 ◽  
Author(s):  
Terrie-Marie Russell ◽  
Anil Hormis ◽  
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Review Literature ◽  
Video Laryngoscope ◽  
Intubation Time ◽  
First Line ◽  
Glottic View ◽  
Glidescope Video Laryngoscope ◽  
Difficult Airways

The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question ‘Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?’ A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.

scholarly journals Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Hyun Young Choi ◽  
Wonhee Kim ◽  
Yong Soo Jang ◽  
Gu Hyun Kang ◽  
Jae Guk Kim ◽  
...  
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Macintosh Laryngoscope ◽  
Secondary Outcome ◽  
Intubation Time ◽  
Chest Compressions ◽  
Intubation Technique ◽  
Endotracheal Tubes ◽  
Significant Difference ◽  
Post Hoc

Purpose. This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods. In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p<0.05 between two devices or p<0.017 in post hoc analysis of the comparison among three devices. Results. The mean intubation time using IGI was shorter (p<0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p<0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p<0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions. IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.

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

JAMA ◽  
2019 ◽  
Vol 322 (23) ◽  
pp. 2303 ◽  
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

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

2019 ◽  
Vol 36 (11) ◽  
pp. 678-683 ◽  
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.

scholarly journals Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260140
Author(s):  
Dóra Keresztes ◽  
Ákos Mérei ◽  
Martin Rozanovic ◽  
Edina Nagy ◽  
Zoltán Kovács-Ábrahám ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Difficult Airway ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Macintosh Laryngoscope ◽  
Dental Trauma ◽  
Esophageal Intubation ◽  
Successful Intubation ◽  
Normal Airway ◽  
Novice Users

Introduction Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. Materials and methods Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. Results In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. Conclusion All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.

Endotracheal Intubation in Patients With COVID-19 By Emergency Physicians in The Tokyo Metropolitan Area

2021 ◽  
Author(s):  
Mitsuhito Soh ◽  
Toru Hifumi ◽  
Norio Otani ◽  
Momoyo Miyazaki ◽  
Kentaro Kobayashi ◽  
...  
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Metropolitan Area ◽  
Patient Characteristics ◽  
Emergency Physicians ◽  
Related Factors ◽  
Tokyo Metropolitan ◽  
Tokyo Metropolitan Area ◽  
Intubation Success ◽  
Intubation Success Rate

Abstract Background: Patients with COVID-19 may require emergency tracheal intubation for mechanical ventilation by emergency physicians. However, the success rate, complications, operator safety, and issues around personal protective equipment (PPE) and barrier enclosure use are not known in this context.Methods: This was a retrospective study of data for adult patients with COVID-19 who underwent endotracheal intubation performed by emergency physicians at four hospitals in the Tokyo Metropolitan Area between January 2020 and September 2020. Patient characteristics, intubation-related factors, and intubation success and complications rates were obtained. Two analyses were then performed. In analysis 1, the intubation success rate in patients was compared among four groups using different types of PPE. In analysis 2, patients were compared by those intubated with or without barrier enclosure.Results: In total, 46 patients met the inclusion criteria, of whom 85% were successfully intubated at the first attempt, 27% experienced hypotension, and 27% experienced hypoxia. No muscle relaxants were used in 8.7% and the Macintosh blade was used in 37%. The four PPE types and the intubation confirmation methods varied considerably, but all met the WHO recommendations. A barrier enclosure device was used in 26%, with a success rate of approximately 80% irrespective of its use.Conclusions: The success rate at the first attempt of intubation was relatively high, albeit with a moderately high complication rate. All PPE types were safe, including when barrier enclosures were used. Success was not affected by using barrier enclosures.

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