Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

Background: The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations. Methods: Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded. Results: There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different. Conclusions: In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.

Efficacy of RAMA Mobile Video Laryngoscope (RAMA-mVL) Versus McGrath® for Tracheal Intubation in Manikin. A Randomized Study

Background: Video laryngoscope (VL) has increased the success rate of intubation but the commercial VL is unaffordable for community hospitals. Therefore, Ramathibodi mobile VL (RAMA-mVL) was invented to close the gap and expected that it would be equivalent to the current device and lower price.Objective: To determine the effectiveness of intubation, compare by using RAMA-mVL and McGrath®Methods: The randomized, single-blinded study of the success intubation between RAMA-mVL and McGrath® was conducted in a manikin. Medical personnel with intubation experiences was included and trained before performing the procedure. The success rate for one best shot of intubation, time to intubation, satisfaction, and value between both VL were recorded and analyzedResults: A total of 208 persons entered the research, 104 in each group. The success rate for intubation by using both VL is 100%. The mean of time to intubation using RAMA-mVL was significantly less than that of McGrath®, which were 9.12 (±4.28) and 11.19 (±5.04) seconds, respectively (95% CI 0.001 - 0.9, P = .002). The satisfaction with innovation that is easy to build between RAMA-mVL and McGrath® was 4.88 (±0.32) and 4.23 (±0.96) points (95% CI 0.46 - 0.85, P < .001). Additionally, the cost of RAMA-mVL was cheaper than McGrath®.Conclusions: RAMA-mVL performed equivalent and even better than McGrath® compared by intubation success rate, mean intubation time, satisfaction, and cost-effectiveness.

Does seniority always correlate with simulated intubation performance? Comparing endotracheal intubation performance across medical students, residents, and physicians using a high-fidelity simulator

Background Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. Methods We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. Results There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. Discussion Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. Conclusion Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians’ knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.

Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial

We hypothesized that external laryngeal manipulation would reduce cervical spine motion during video laryngoscopic intubation under manual in-line stabilization by reducing the force required to lift the videolaryngoscope. In this randomized crossover trial, 27 neurointerventional patients underwent two consecutive videolaryngoscopic intubation attempts under manual in-line stabilization. External laryngeal manipulation was applied to all patients in either the first or second attempt. In the second attempt, we tried to reproduce the percentage of glottic opening score obtained in the first attempt. Primary outcomes were cervical spine motion during intubation at the occiput-C1, C1–C2, and C2–C5 segments. The intubation success rate (secondary outcome measure) was recorded. Cervical spine motion during intubation at the occiput-C1 segment was significantly smaller with than without external laryngeal manipulation (7.4° ± 4.6° vs. 11.5° ± 4.8°, mean difference −4.1° (98.33% confidence interval −5.8° to −2.3°), p < 0.001), showing a reduction of 35.7%. Cervical spine motion during intubation at the other segments was not significantly different with versus without external laryngeal manipulation. All intubations were achieved successfully regardless of the application of external laryngeal manipulation. External laryngeal manipulation is a useful method to reduce upper cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.

Role of Trachway versus Conventional Modes of Intubation in Difficult Airway Management in COVID-19 Setups

Difficult airway management in critically ill patients remains a difficult task associated with high morbidity and mortality rates. In difficult airway populations, prompt effective intubation is more important to prevent hypoxia and neurological injury. During the ongoing COVID-19 pandemic, prolonged intubation time and repeated intubation can lead to an increase in the risk of infection. Therefore, digital devices can shorten intubation times and decrease the risk of infection among clinical staff. The advantages of the Trachway videolight intubating stylet suit these conditions. Trachway stylet intubation is an effective method for video laryngoscopy to enhance patient safety and improve the intubation success rate. However, a few studies have focused on the effect of stylet intubation by reducing repeated intubation and oxygen desaturation. In this study, we reviewed current data of Trachway intubation and shared our four major training scenarios in Taipei Tzu Chi Hospital via the Trachway videolight intubating stylet system for emergency intubation, comparing them with other modes of intubation.

Systematic Review Comparison of Endotracheal Intubation Success Rate Using McGrath® Mac Videolaryngoscope with Direct Laryngoscope (Macintosh): A Manikin Studies

Introduction: McGrath® MAC videolaryngoscope is a single-handed device designed to facilitate intubation in patients both in patients with normal airway conditions (without any complications) or airway conditions with complications such as cervical spine and/or anatomic abnormalities. Objective: This study aims to compare McGrath® MAC videolaryngoscope and direct laryngoscope using Macintosh blades as learning material or study simulators for medical personnel (including anesthesiologist and paramedics) and novice operator (medical students). Method: this study is a systematic review using the PRISMA method which was carried out systematically. Data was collected through Pubmed, direct science, EBSCOHost, and Proquest using the keywords ‘airway management ', ‘laryngoscopy', and 'manikin'. Journal included based on published publication time between 2008 and 2020, a study using SimMan Laerdal Airway manikin, a journal discussing intubation using McGrath® MAC videolaryngoscope and direct laryngoscope with Macintosh blades here, where it is normal airway (without complications) and difficult airway. Results: 1556 journals were collected through 4 journal search sites and then carried out a screening process for the publication year approved in 2008 to 2020. Four studies use adult manikin SimMan Laerdal Airway including 247 participants were included in this systematic review. Conclusion: Based on journals that have been reviewed, McGrath® MAC videolaryngoscope provides better and superior results compared to Macintosh in terms of the success rate and visualization of glottis. Also, the intubation time using McGrath® MAC videolaryngoscope is shorten compared to Macintosh both on the normal airway (without complication) and difficult airway. The participants (medical personnel and novice operators) in all studies that reviewed prefer to use McGrath® Mac videolaryngoscope instead of using direct laryngoscope with Macintosh blade for Endotracheal Intubation mainly used for learning or study simulators.

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

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.

First-Attempt Endotracheal Intubation Success Rate Using A Telescoping Steel Bougie

Background There has been a renewed interest in using the plastic intubation bougie to facilitate first-attempt endotracheal intubation success. The sterile single-use telescopic steel bougie (AIROD) was invented to overcome the limitations of the plastic bougie which is easily deformed during storage. Methods This is a retrospective study involving critically ill patients who were intubated with the AIROD in the intensive care unit at a single institution. The purpose of this case series is to compare the success rate of the AIROD to the generally accepted success rate for the traditional plastic bougie of 96%. Results A total of 54 patients were enrolled at a single ICU over a 10 months period. All patients were critically ill with 76% having a difficult airway, Cormack-Lehane grade view 2 or greater in 60%, and ARDS secondary to COVID-19 in 54%. The primary outcome of first-attempt intubation success in critically ill patients intubated in the ICU with the AIROD was 97% with a 95% confidence interval of 0.89 to 0.99. The average time for intubation of all airway classifications was 15 seconds. Conclusion The AIROD first-attempt intubation success rate was found to be similar to the rate for the traditional plastic bougie.