Articulating Video Stylets in the Setting of Simulated Traumatic Cervical Spine Injury: A Comparison with Four Other Devices and Approaches to Endotracheal Intubation

Abstract

Background: Simulation offers the opportunity to train healthcare professionals in complex scenarios, such as those with as traumatized patients. Methods: We conducted an observational cross-sectional research simulating trauma with cervical immobilization. We compared five techniques/devices: direct laryngoscopy (DL), videolaryngoscopy (VLS, Glidescope or McGrath), combined laryngo-bronchoscopy intubation (CLBI) and articulating video stylet (ProVu). The primary outcomes were as follows: (1) success rate (SR) by third attempt (each lasting up to 60 s), and (2) corrected time-to-intubation (cTTI, accounting for failed attempts). Results: In a single center, we enrolled 42 consultants experienced in DL/VLS, but reporting no experience with ProVu, and hypothesized that ProVu would have offered encouraging performances. By the third attempt, ProVu had a SR of 73.8%, identical to Glidescope (p = 1.00) and inferior only to McGrath (97.6%; p = 0.003). The cTTI (seconds) of ProVu (57.5 [45–174]) was similar to Glidescope (51.2 [29–159]; p = 0.391), inferior to DL and McGrath (31.0 [22–46]; p = 0.001; and 49.6 [27–88]; p = 0.014, respectively), and superior to CLBI (157.5 [41–180]; p = 0.023). Conclusions: In consultants with no experience, as compared to DL and VLS, the video stylet ProVu showed encouraging results under simulated circumstances of cervical immobilization. The results should be interpreted in light of the participants being novices to ProVu and skilled in DL/VLS. Adequate training is required before the clinical introduction of any airway device.