Airway management during ongoing chest compressions–direct vs. video laryngoscopy. A randomised manikin study

Abstract

Background Tracheal intubation is used for advanced airway management during cardiac arrest, particularly when basic airway techniques cannot ensure adequate ventilation. However, minimizing interruptions of chest compressions is of high priority. Video laryngoscopy has been shown to improve the first-pass success rate for tracheal intubation in emergency airway management. We aimed to compare first-pass success rate and time to successful intubation during uninterrupted chest compression using video laryngoscopy and direct laryngoscopy. Methods A total of 28 anaesthetists and 28 anaesthesia nurses with varied clinical and anaesthesiological experience were recruited for the study. All participants performed a tracheal intubation on a manikin simulator during ongoing chest compressions by a mechanical resuscitation device. Stratified randomisation (physicians/nurses) was performed, with one group using direct laryngoscopy and the other using video laryngoscopy. Results First-pass success rate was 100% (95% CI: 87.9% - 100.0%) in the video laryngoscopy group and 67.8% (95% CI: 49.3% - 82.1%) in the direct laryngoscopy group [difference: 32.2% (95% CI: 17.8% - 50.8%), p<0.001]. The median time for intubation was 27.5 seconds (IQR: 21.8–31.0 seconds) in the video laryngoscopy group and 30.0 seconds (IQR: 26.5–36.5 seconds) in the direct laryngoscopy group (p = 0.019). Conclusion This manikin study on tracheal intubation during ongoing chest compressions demonstrates that video laryngoscopy had a higher first-pass success rate and shorter time to successful intubation compared to direct laryngoscopy. Experience in airway management and professional group were not significant predictors. A clinical randomized controlled trial appears worthwhile.

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…Although visualization of the vocal cords could be improved by using VL compared with direct laryngoscopy, whether better visualization consistently improves first-attempt success rate during rapid sequence oro-tracheal intubation remains to be an issue [135][136][137]. Such application of VL has been studied in the settings of emergency department [101,138], out-of-hospital field [139][140][141], intensive care units [101], and simulated cardiopulmonary resuscitation manikin studies [142,143]. The inconsistent results of the role of VL are probably based on the airway operator's training skill, experience, and clinical competency.…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…Although visualization of the vocal cords could be improved by using a VL compared with direct laryngoscopy, whether better visualization consistently improves first-attempt success rate during rapid sequence oro-tracheal intubation remains to be an issue [135][136][137]. Such application of a VL has been studied in the settings of emergency department [101,138], out-of-hospital field [139][140][141], intensive care units [101], and simulated cardiopulmonary resuscitation manikin studies [142,143]. The inconsistent results of the role of a VL are probably based on the airway operator's training skill, experience, and clinical competency.…”