Redefining the Gold Standard of Advanced Airway Management: Use of A Dual Camera Input Screen to Facilitate Video laryngoscope-Assisted Fibreoptic intubating Videoendoscopic endotracheal Intubation

2019 ◽  
Vol 2 (2) ◽  
pp. 8-12
Author(s):  
Dr. Rajkumar Rajendram
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Gold Standard ◽  
Video Laryngoscope ◽  
Advanced Airway

scholarly journals Impact of Video Laryngoscopy on Advanced Airway Management by Critical Care Transport Paramedics and Nurses Using the CMAC Pocket Monitor

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Bradley Boehringer ◽  
Michael Choate ◽  
Shelley Hurwitz ◽  
Peter V. R. Tilney ◽  
Thomas Judge
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Gold Standard ◽  
Video Laryngoscope ◽  
Success Rates ◽  
Complex Process ◽  
Advanced Airway ◽  
Intubation Success ◽  
First Pass ◽  
Active Video

Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08.

scholarly journals An Exploration and Technical Notes for Advanced Airway Management on the Ski Slope: A Simulation Experiment

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Peng Bai ◽  
Tian Xia ◽  
Zhongwei Yang ◽  
Wei Huai ◽  
Xiangyang Guo ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Operation Time ◽  
Laryngeal Mask ◽  
Bite Block ◽  
Optimal Method ◽  
Artificial Airway ◽  
Advanced Airway ◽  
Laryngeal Mask Insertion ◽  
Significant Difference

Background. Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports. During skiing rescue, the harsh natural environments will increase the difficulty of artificial airway establishment. There has been no research focusing on the establishment of the artificial airway during skiing rescue site. This study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope. Methods. The simulated human was placed on the cold slope with the head under the feet. Artificial airway was established by the same anesthesiologist using endotracheal intubation (endotracheal intubation group), LMA Supreme laryngeal mask (LMA group), and I-gel laryngeal mask (I-gel group). Each method was repeated 5 times, and the operation time and whether it was successful by one attempt were recorded and compared between groups. Results. Three groups of artificial airway were successful by one attempt.. The bite block dropped and drifted away for one time in the endotracheal intubation group. Operation time is 209.2 ± 32.7 seconds in the endotracheal intubation group, 72.2 ± 3.1 seconds in the LMA group, and 52.6 ± 4.2 seconds in the I-gel group. ANOVA showed that there was a significant difference in the operation time among the three groups ( p < 0.001 ). Tukey’s post hoc test showed that there were statistically significant differences between the endotracheal intubation group and the other two groups in operation time, p < 0.001 , while there was no significant difference between the LMA group and I-gel group ( p = 0.275 ). Conclusion. The artificial airway can be completed by endotracheal intubation and LMA and I-gel laryngeal mask insertion on the cold slope. Artificial airway with the I-gel laryngeal mask takes the shortest time in this study. Extra caution should be paid to slippery and drifting.

scholarly journals Endotracheal intubation—still the gold standard in out-of-hospital cardiac arrest airway management?

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Jonathan Teng Fai Loke ◽  
Seth En Teoh ◽  
John J. Y. Zhang ◽  
Yoshio Masuda
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Gold Standard ◽  
Hospital Cardiac Arrest

Advanced airway management

2019 ◽  
pp. 153-176
Author(s):  
Richard Craig
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Video Laryngoscope ◽  
Flexible Bronchoscope ◽  
Airway Assessment ◽  
Advanced Airway ◽  
Induction Of Anaesthesia ◽  
Structured Approach

Management of the difficult paediatric airway is described in this chapter. Airway assessment and a structured approach to planning for the anticipated difficult airway are the essence of the chapter. This includes a plan for induction of anaesthesia, a plan for laryngoscopy and intubation, and a plan for safe extubation. Detailed, step-by-step guides describing the techniques for intubation using a flexible bronchoscope, Macintosh-style video laryngoscope, and rigid optical stylet are provided. The conditions commonly associated with the difficult paediatric airway are classified according to the mechanism by which they cause difficulty.

scholarly journals The Most Accurate and Fastest Method for Confirmation of Endotracheal Intubation

2017 ◽  
Vol 5 (4) ◽  
pp. 32
Author(s):  
Zahra Parsian ◽  
Farzad Rahmani ◽  
Hassan Soleimanpour
Keyword(s):  
Cardiac Output ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Tracheal Tube ◽  
Standard Method ◽  
Gold Standard ◽  
Direct Visualization ◽  
Gold Standard Method ◽  
Correct Placement

Tracheal intubation and confirming correct placement of tracheal tube is one of the most important subjects in patients who need airway management (1). Gold standard method of confirmation is capnography, but it is just applicable in patients with tangible cardiac output. Other methods of confirming endotracheal intubation such as hearing gurgling sounds in epigastria, auscultation of lungs sounds, esophageal detector device, and chest radiography can be used for this purpose (2). Recently an exact real time, contrary to other methods, method of confirming endotracheal intubation has been developed which is direct visualization of tracheal tube passage through trachea with sonography. Considering the advantages of sonography, it is strongly recommended for the confirmation of endotracheal intubation(3).

scholarly journals Paramedic Perception of Endotracheal Intubation Performance: an Examination of Irish Advanced Paramedic Demographics, Characteristics, Confidence and Perceived Barriers to the Performance of Advanced Airway Management.

2021 ◽  
Author(s):  
Alan Horan ◽  
Siobhán Masterson ◽  
Cathal O'Donnell ◽  
David Hennelly
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Clinical Skill ◽  
Hybrid Approach ◽  
Hospital Setting ◽  
Personal Characteristics ◽  
Perceived Barriers ◽  
Intubation Attempt ◽  
Online Questionnaire ◽  
Advanced Airway

Abstract BackgroundMuch research has occurred internationally with regard to the prehospital ETI (endotracheal intubation), however to date little is known of Paramedics perception of the procedure. In order to gain insight into procedural perception Irish Advanced Paramedics (AP) were invited to participate in an electronic survey. This survey attempted to gather information surrounding AP’s experience of education for and performance of ETI, to identify procedural barriers and gain insight in to the continuing developmental needs of AP’s to maintain confidence and competence in ETI performance. MethodsAn online questionnaire was created and AP’s employed by the National Ambulance Service and the Dublin Fire Brigade, were invited to participate. The objective was to measure the characteristics, attitudes and perceived barriers to ETI by AP’s in Ireland. Participants were asked to categorise their personal characteristics of ETI (frequency, techniques, barriers) through a series of 36 structured questions and answers. ResultsOf the 524 AP surveyed the response rate was 27% (n=140) 77.9% of respondents perform ETI 10 times or less per year. 26.6% of respondents maintain a personal airway management log book. 97.8% of respondents reported ETI as being an important AP skill. Most felt confident at performing the procedure but felt it was of moderate difficulty. There was a lack of consensus on the definition of a failed intubation attempt. Initial supervised intubation practice in Hospital or the clinical skill lab was felt to be very important. Most respondents felt that there should be a minimum number of intubations performed by a paramedic each year, and that if this number was not achieved in the pre-hospital setting in-hospital practice should be an available alternative.Conclusion ETI is perceived to be an important skill by Paramedics. In practice there is wide variances in standards of data reporting, continuing assessment and competency assurance in ETI. A hybrid approach of individuals maintaining an airway portfolio which encompasses a clinical airway logbook, self-directed airway simulation with periodic senior peer appraisal and in-hospital clinical feedback may be the best approach for Paramedics with limited pre-hospital advanced airway management opportunities.

scholarly journals Endotracheal Intubation Using the Macintosh Laryngoscope or KingVision Video Laryngoscope during Uninterrupted Chest Compression

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Ewelina Gaszynska ◽  
Tomasz Gaszynski
Keyword(s):  
Endotracheal Intubation ◽  
Macintosh Laryngoscope ◽  
Video Laryngoscope ◽  
Chest Compressions ◽  
Success Ratio ◽  
Primary Endpoints ◽  
Advanced Airway ◽  
The Mean ◽  
Time Required ◽  
Mean Time

Objective.Advanced airway management, endotracheal intubation (ETI), during CPR is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to assess the performance of the KingVision video laryngoscopes in a manikin cardiopulmonary resuscitation (CPR) scenario.Methods.Thirty students enrolled in the third year of paramedic school took part in the study. The simulated CPR scenario was ETI using the standard laryngoscope with a Macintosh blade (MCL) and ETI using the KingVision video laryngoscope performed during uninterrupted chest compressions. The primary endpoints were the time needed for ETI and the success ratio.Results.The mean time required for intubation was similar for both laryngoscopes: 16.6 (SD 5.11, median 15.64, range 7.9–27.9) seconds versus 17.91 (SD 5.6, median 16.28, range 10.6–28.6) seconds for the MCL and KingVision, respectively (P=0.1888). On the first attempt at ETI, the success rate during CPR was comparable between the evaluated laryngoscopes:P=0.9032.Conclusion.The KingVision video laryngoscope proves to be less superior when used for endotracheal intubation during CPR compared to the standard laryngoscope with a Mackintosh blade. This proves true in terms of shortening the time needed for ETI and increasing the success ratio.

scholarly journals 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

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.

Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment

2017 ◽  
Vol 32 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Sami Yousif ◽  
Jason T. Machan ◽  
Yasser Alaska ◽  
Selim Suner
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Personal Protective Equipment ◽  
Disaster Response ◽  
Macintosh Laryngoscope ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Protective Equipment ◽  
Manikin Study

AbstractIntroductionAirway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control.Hypothesis/ProblemThe objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.MethodsIn this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device.ResultsA total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons).ConclusionUse of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use.YousifS, MachanJT, AlaskaY, SunerS. Airway management in disaster response: a manikin study comparing direct and video laryngoscopy for endotracheal intubation by prehospital providers in Level C personal protective equipment. Prehosp Disaster Med. 2017;32(4):352–356.

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