scholarly journals Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

2021 ◽  
Vol 10 (24) ◽  
pp. 5740
Author(s):  
Leszek Gadek ◽  
Lukasz Szarpak ◽  
Lars Konge ◽  
Marek Dabrowski ◽  
Dominika Telecka-Gadek ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Crossover Trial ◽  
Life Support ◽  
Protective Equipment ◽  
Intubation Time ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
Randomized Crossover Trial ◽  
Intubation Success ◽  
First Pass

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

scholarly journals Comparison of Pentax-AWS Airwayscope and Glidescope for Infant Tracheal Intubation by Anesthesiologists during Cardiopulmonary Arrest Simulation: A Randomized Crossover Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Shunsuke Fujiwara ◽  
Nobuyasu Komasawa ◽  
Sayuri Matsunami ◽  
Daisuke Okada ◽  
Toshiaki Minami
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Crossover Trial ◽  
Cardiopulmonary Arrest ◽  
Intubation Time ◽  
Chest Compressions ◽  
Analog Scale ◽  
Randomized Crossover Trial ◽  
Better Than

Background. Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airwayscope (AWS) with the Glidescope (GS) during chest compressions on an infant manikin.Methods. Twenty-four anesthesiologists with more than two years of experience performed tracheal intubation on an infant manikin using the AWS and GS, with or without chest compressions.Results. In GS trials, none of the participants failed without compressions, while three failed with compressions. In AWS trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the GS (P<0.05), but not with the AWS. Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not increase significantly with chest compressions with either the GS or the AWS, while the VAS for tube passage through the glottis increased with compressions with the GS, but not with the AWS.Conclusion. We conclude that in infant simulations managed by anesthesiologists, the AWS performed better than the GS for endotracheal intubation with chest compressions.

Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study

2019 ◽  
Vol 37 (05) ◽  
pp. 519-524
Author(s):  
Yuri Ozawa ◽  
Shigehiro Takahashi ◽  
Humiko Miyahara ◽  
Kenichiro Hosoi ◽  
Mazumi Miura ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Neonatal Intensive Care ◽  
Crossover Trial ◽  
Linear Models ◽  
Video Laryngoscopy ◽  
Neonatal Intensive Care Units ◽  
Intubation Time ◽  
Randomized Crossover Trial ◽  
Side Walls ◽  
Randomized Crossover Study

Abstract Objective The use of video laryngoscopy for intubating neonates in ergonomically challenging settings has not been studied well. We aimed to assess the usefulness of video laryngoscopy for experienced neonatologists to intubate neonatal manikins in incubators via side hand ports or head window. Study Design In this randomized crossover trial at three neonatal intensive care units in Japan, 27 neonatologists were randomized into two groups, namely, those intubating neonatal simulators using video laryngoscopy and then using direct laryngoscopy, or vice versa. The intubations were performed via hand ports or head window without opening top and side walls in incubators in two manikin positions (rotated 90° or unrotated). Glottis visualization (0–100%), success rate, intubation time, and ease of laryngoscopy (from 1 [very difficult] to 10 [very easy]) were compared between video laryngoscopy and direct laryngoscopy. Generalized linear models were used for the analyses. Results This study assessed 108 intubations performed by 27 neonatologists. The use of video laryngoscopy improved the glottis visualization by 14% (95% confidence interval, 7.4–20%; p < 0.01) and easiness scores of laryngoscopy by 0.8 (0.2–1.4; p < 0.01), but did not reduce the intubation time. Conclusion Video laryngoscopy is useful for experienced neonatologists for intubating neonatal manikins in incubators without opening the top or side walls.

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.

A stabilization device to improve the quality of cardiopulmonary resuscitation during ambulance transportation: A randomized crossover trial

Resuscitation ◽  
2013 ◽  
Vol 84 (11) ◽  
pp. 1579-1584 ◽  
Author(s):  
Ning-Ping Foo ◽  
Jer-Hao Chang ◽  
Shih-Bin Su ◽  
Hung-Jung Lin ◽  
Kow-Tong Chen ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Crossover Trial ◽  
Randomized Crossover Trial

scholarly journals Does Video Laryngoscopy or Direct Laryngoscopy affect first pass success rates for intubation among Attending and Non-Attending Emergency Physician in the Emergency Department?

2019 ◽  
Author(s):  
Paul Weng Wan ◽  
Zakaria Nur Diana ◽  
Seow Gek Ching ◽  
Wong Evelyn
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
First Pass ◽  
Lemon Score

Abstract Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending Emergency Physicians in South-East Asia. We aim to identify whether the use of Direct Laryngoscopy (DL) compared to Video Laryngoscopy (VL) affects first pass success rates between Attending Emergency Physicians (AEP) and Non-Attending Emergency Physicians (NAEP). Materials and Methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by and academic Emergency Department in Singapore. Primary outcome is first pass success intubation rate. The secondary outcome was first pass success rate for difficult intubations. Difficult intubations were defined as LEMON score of more than 1 or more than 1 attempt at intubation. Results: There were 2909 intubation carried out by emergency physicians in the Emergency Department from 2009 to 2016. AEP conducted 1748 intubations while NAEP conducted 1161 intubations. The first pass success rates for AEP was 84.2% while that for NAEP was 67.4%. 86.2% of intubations by AEP were done with a direct laryngoscope. 89.0% of the intubations by NAEP were done with a direct laryngoscope. 18.9% of intubations by the AEP were difficult compared to 35.2% by the NAEP (p<0.01 95% C.I 13.0%-19.6%). First pass success rate with VL was lower than DL for all intubations (OR 0.66, 95% C.I 0.51-0.84). In the subgroup of difficult intubations, VL did not improve first pass success rate among AEP (OR 0.77, 95% C.I 0.38-1.58) but it did for NAEP (OR 2.46, 95% C.I 0.94-6.45). Conclusion: Our study showed that VL has a poorer first pass success rate for all intubations in general. However, specifically for difficult intubations, VL is associated with improved first pass success rates among NAEP.

scholarly journals Comparison of three video laryngoscopes and direct laryngoscopy for emergency endotracheal intubation: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024927 ◽  
Author(s):  
Kei Suzuki ◽  
Shinji Kusunoki ◽  
Koichi Tanigawa ◽  
Nobuaki Shime
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Macintosh Laryngoscope ◽  
Success Rates ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Intubation Success ◽  
Fisher’S Exact Test ◽  
First Pass

ObjectiveVideo laryngoscopes are used for managing difficult airways. This study compared three video laryngoscopes’ (Pentax-Airway Scope [Pentax], King Vision[King] and McGrath MAC [McGrath]) performances with the Macintosh direct laryngoscope (Macintosh) as emergency tracheal intubations (TIs) reference.DesignRetrospective cohort study.SettingThe emergency department (ED) and the intensive care unit (ICU) of two Japanese tertiary-level hospitals.ParticipantsAll consecutive video-recorded emergency TI cases in EDs and ICUs between December 2013 and June 2015.Primary outcome measuresThe primary study endpoint was first-pass intubation success. A subgroup analysis examined the first-pass intubation success of expert versus non-expert operators. A logistic regression analysis was performed to identify the predictors of first-pass intubation success.ResultsA total of 287 emergency TIs were included. The first-pass intubation success rates were 78%, 58%, 78% and 58% for the Pentax, King, McGrath and Macintosh instruments, respectively (p=0.004, Fisher’s exact test). The non-expert operators’ success rates were significantly higher (p=0.00004, Fisher’s exact test) for the Pentax (87%) and McGrath (78%) instruments than that for the King (50%) and Macintosh (46%) instruments, unlike that of the experts (67%, 67%, 78% and 78% for Pentax, McGrath, King and Macintosh, respectively; p=0.556, Fisher’s exact test). After TI indication, difficult airway characteristics, and expert versus non-expert operator parameters adjustments, the Pentax (OR=3.422, 95% CI 1.551 to 7.550; p=0.002) and McGrath (OR= 3.758, CI 1.640 to 8.612; p=0.002) instruments showed significantly higher first-pass intubation success odds when compared with the Macintosh laryngoscope (reference, OR=1). The King instrument, however, (OR=1.056; 95% CI 0.487 to 2.289, p=0.889) failed to show any significant superiority.ConclusionThe Pentax and McGrath laryngoscopes showed significantly higher emergency TI first-pass intubation success rates than the King laryngoscope when compared with the Macintosh laryngoscope, especially for non-expert operators.Trial registration numberUMIN000027925; Results.

PP14 Soiled airway tracheal intubation and the effectiveness of decontamination (SATIATED) by paramedics: a randomised controlled manikin study

2019 ◽  
Vol 36 (10) ◽  
pp. e7.1-e7
Author(s):  
Richard Pilbery ◽  
M Dawn Teare
Keyword(s):  
Training Session ◽  
Intubation Time ◽  
Success Rates ◽  
The Third ◽  
Significant Difference ◽  
First Pass ◽  
Patient Will ◽  
The Mean ◽  
Randomised Controlled ◽  
Hospital Cardiac Arrest

BackgroundIn more than one-in-five cases of out-of-hospital cardiac arrest, the patient’s airway is soiled by vomit and blood. If a paramedic cannot clear the airway, the patient will die. A new method of clearing the airway called suction assisted laryngoscopy and airway decontamination (SALAD) has been developed, but it’s not known whether the method can assist paramedics to intubate. This study aims to determine whether paramedics can intubate a simulated soiled airway more often on their first attempt, using SALAD.MethodsA modified airway manikin, with the oesophagus connected to a reservoir of ‘vomit’ that was propelled up the oesophagus by a pump, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.Results164 paramedics took part in the study. First-pass intubation success with and without SALAD was 90.2% and 53.7% respectively, a significant difference of 36.6% (95%CI 24–49.1%, p<0.001). The mean successful intubation time for each attempt and patient group (AAB and ABB) was as follows: 61.8 (95%CI 55.8–67.8) and 59.4 (95%CI 53.6–65.1) seconds on the first attempt, 50.8 (95%CI 45.7–55.9) and 51.5 (95%CI 48.6–54.4) seconds on the second attempt and 53.5 (95%CI 50.4–56.6) and 46.6 (95%CI 44.0–49.1) seconds on the third attempt. There was no significant difference in success rates on the third attempt between AAB and ABB 89% vs 86.6% respectively, a difference of 2.4% (95%CI 7.6–12.4%, p=0.63).ConclusionsIn this study, paramedics were able to intubate a simulated soiled airway on their first attempt, significantly more often when using the SALAD technique.

PP23  Soiled airway tracheal intubation and the effectiveness of decontamination by north east paramedics: a randomised controlled manikin study. The satiated2 study

2020 ◽  
Vol 37 (10) ◽  
pp. e11.1-e11
Author(s):  
Graham McClelland ◽  
Richard Pilbery ◽  
Sarah Hepburn
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Ambulance Service ◽  
Success Rates ◽  
North East ◽  
Significant Difference ◽  
Intubation Success ◽  
First Pass ◽  
Intubation Success Rate ◽  
Randomised Controlled

BackgroundVomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways.A technique called Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) has been developed to help clinicians manage these difficult airways. The only UK SALAD study (SATIATED) reported improved paramedic first-pass intubation success rate. This study has now been replicated in a different ambulance service.The primary research question was: Does paramedic first-pass intubation rate in North East Ambulance Service improve following training in SALAD? The secondary research question was: Does training in SALAD affect the time taken to intubate by paramedics?MethodsA randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting to simulate a soiled airway. The intervention comprised SALAD training and the introduction of the DuCanto catheter for post-training attempts. Participants were randomised into two groups: A01A02B01 who made two pre-training intubation attempts and one post-training attempt, and A11B11B12, who made one pre-training and two post-training attempts. Data were collected on length of service, success rates, timings and techniques used.ResultsParamedics (n=102 participants, n=99 completed the study) were recruited between August and December 2019. First-pass intubation success rates on the second attempts (A02versus B11) were 86% and 96% respectively; a non-significant improvement of 10% (95% CI 1–21%, p=0.09). Both groups intubated faster on third attempts compared to first attempts. A01 to B01 mean improvement 5 (SD 14) seconds, A11 to B12 mean improvement 9 (SD 15) seconds. There was no significant difference in improvement between groups (mean difference -4 seconds, 95% CI -11–3 seconds, p=0.22).ConclusionsNorth East Ambulance Service paramedics demonstrated improved first-pass intubation success rates in a simulated soiled airway following SALAD training and improved time to intubation. This study supports the findings of the SATIATED study.

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