Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation

Ładny, Jerzy Robert; Sierżantowicz, Regina; Kędziora, Jarosław; Szarpak, Łukasz

doi:10.1016/j.ajem.2016.12.026

Cited by 20 publications

(8 citation statements)

References 8 publications

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“…In the case of direct laryngoscopy, the learning curve, as shown by numerous studies, illustrates 43-75 attempts required for achieving successful intubation (34)(35)(36). The present study indicates an acceleration of the learning curve with videolaryngoscopy, and this is also confirmed in studies by Baciarello et al (37), Aghamohammadi et al (38), and other authors (13,39,40).…”

Section: Discussionsupporting

confidence: 89%

“…Videolaryngoscope is used not only in elective cases in the operating theatre during difficult intubation but also in emergency medicine (12). Many surveys, including manikin studies and human studies (13,14), indicate that the duration of endotracheal intubation is shorter compared with direct laryngoscopy, especially in difficult airways, as this is not always confirmed in the case of normal airways (14). Although in critical care settings, in patients undergoing endotracheal intubation, videolaryngoscopy improves glottic visualization, it does not appear to increase procedural success or decrease complications (15).…”

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confidence: 99%

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Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

Korkut¹,

Szarpak²,

Evrın³

et al. 2019

Eurasian J Emerg Med

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IntroductionTracheal intubation is the gold standard for airway management. The advantages of endotracheal intubation include reliable ventilation, separation of the airway from the gastrointestinal tract, significant reduction of regurgitation risk, the possibility to suction the respiratory tract, and to ventilate in further patient care conditions, including intensive care units (1,2). Endotracheal intubation can be performed with many techniques, but direct Aim: Tracheal intubation is challenging in emergency medicine, especially in pre-hospital settings, owing to problems connected with patients, intubator, and the environment. The study aimed to compare the effectiveness of endotracheal intubation performed by paramedics with the use of direct laryngoscopy and the McGrath MAC videolaryngoscope in standard and difficult airway settings. Materials and Methods:The study was designed as a prospective, randomized, cross-over simulation study. It involved 52 paramedics. The participants performed endotracheal intubation in two scenarios: Normal airway and difficult airway, achieved by inflation of the simulator tongue to the level of difficulty determined by an independent instructor at grade 3 on the Cormack-Lehane scale. The primary endpoint was the success of endotracheal intubation; intubation time constituted the secondary endpoint. Results:The median age of participants was 24 years [interquartile range (IQR): 23-25], and the median work experience was 0.5 years (IQR: 0-1). In normal airway (scenario A), the effectiveness of the first intubation attempt was 92.3% for MAC and 96.2% for McGrath (p=0.724). The median intubation time for MAC was 19 (IQR: 14-21.5) seconds and was statistically significantly longer than 16 (12.5-20) seconds for McGrath (p=0.047). The ease of intubation was 18 (IQR: 10-20) points for McGrath and 25 (IQR: 16-27) points for MAC (p=0.035). In difficult airway (scenario B), the efficacy of the first intubation attempt for MAC and McGrath equaled 40.4% and 82.7%, respectively. The median intubation time for McGrath was 19 (IQR: 14-27.5) seconds and was significantly shorter than 25 (IQR: 24-39) seconds for MAC (p=0.007). The degree of glottis visualization was statistically significantly better in McGrath than in MAC (p<0.001). The ease of intubation was 25 (IQR: 20-32) points for McGrath and 49 (IQR: 34-58) points for MAC (p<0.001). Overall, 96.2% of subjects intubating in difficult airway conditions chose the McGrath videolaryngoscope as their preferred intubation method as compared with MAC. Conclusion:In the simulation study, endotracheal intubation in difficult airway conditions performed by paramedics using McGrath video laryngoscopy was associated with shorter procedure duration, better glottis visualization, and higher efficacy of the first intubation attempt. The study showed that paramedics were able to intubate using the McGrath videolaryngoscope with higher efficiency than in the case of a standard Macintosh laryngoscope after a short training.

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Section: Discussionsupporting

confidence: 89%

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confidence: 99%

Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

Korkut¹,

Szarpak²,

Evrın³

et al. 2019

Eurasian J Emerg Med

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“…Securing airway patency is an important aspect of resuscitation. [ 34 , 35 ] Recommendations indicate that a person qualified in endotracheal intubation should use this method. [ 36 ] According to the research, 51.4% of patients were intubated, and a large number of them were provided assistance with supraglottic airway methods.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest

et al. 2018

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Sudden cardiac arrest (SCA) is a significant medical and social issue, the main cause of death in Europe and the United States.The aim of the research was to evaluate the effectiveness of emergency medical procedures applied by emergency medical teams in prehospital care in the context of return of spontaneous circulation (ROSC).The case–control study was based on the medical documentation of the Rescue Service in Katowice (responsible for monitoring 2.7 million inhabitants of the region) referring to 2016. The research involved exclusively adults (ie, individuals older than 18 years) with out-of-hospital cardiac arrest (OHCA). After considering the above inclusion criteria, there were 1603 dispatch order forms (0.64% of all dispatch orders) involved in further research.On the basis of the emergency medical procedure forms, the actions of emergency medical teams were verified as medical procedures (endotracheal intubation, the use of suction pumps, defibrillation, the use of alternatives providing airway patency and ROSC was determined.The analysis covered 1603 cases of OHCA. SCA turned out more frequent in men than in women (P = .000). Most often, SCA occurred in domestic conditions during the day and was witnessed by a third person. In 59.9% of the cases, actions were taken by witnesses, which increased the probability of ROSC. Patients were usually intubated (51.4%). Respirators were used less frequently (20.2%). Ventricular fibrillation (VF) was reported only in 22.0% of the cases. The ROSC rate was higher in the group of patients with diagnosed VF than in those with nonshockable rhythms (VF, 55.43% vs asystole, 24.05%; P = .000).Successful resuscitation depends on the quality of emergency medical procedures performed at the place of incident. The highest probability of ROSC is related with defibrillation (in the cases of VF or ventricular tachycardia with no pulse), intubation, the application of a respirator, and performing mechanical ventilation, as well as with a shorter time from dispatch to arrival.

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“…Current guidelines for resuscitation [2,15] recommend that endotracheal intubation be performed by the most experienced person on the team and that it be carried out without the need to stop compressing the chest or only with a short interval allowing the insertion of the endotracheal tube between the vocal folds. Numerous studies indicate a decrease in the effectiveness of direct laryngoscopy in the case of intubation in conditions of resuscitation with continuous chest compressions [16][17][18]. This is related to difficulties in visualising the glottis when the patient is moving due to chest compressions [16,17].…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

Bielski¹,

Szarpak²,

Pyda³

2018

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Introduction: The main causes of cardiac arrest in paediatric patients are airway obstruction and progressive hypoxia. Rapid endotracheal intubation and the implementation of mechanical ventilation during cardiopulmonary resuscitation (CPR) can affect the minimisation of chest compressions and adequate oxygenation of the blood, and thus increase the chances of spontaneous circulation return. Aim of the study: The aim of the study was to compare intubation using a standard Macintosh blade (MAC) laryngoscope and blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask (AMBU) as a guide for the tracheal tube under simulated CPR conditions of a paediatric patient with and without chest compressions. Material and methods: Fifty-six students from the final year of medicine studies participated in this trial. The study was designed as a randomised, cross-over, simulation study. Participants of the study performed endotracheal intubation during simulated CPR of a paediatric patient, with and without chest compressions during an intubation procedure. Participants had a maximum of three attempts to intubate each of the techniques in individual research scenarios. Results: The median time of intubation in CPR without chest compressions using MAC and AMBU was 32 s (interquartile range-IQR; 27-41.5) and 30 s (IQR; 22-43), respectively. The efficacy of the first intubation trial was 28.6% for MAC and 48.2% for AMBU, and the total intubation efficiency for both techniques was 100%. In the case of intubation during uninterrupted chest compressions, blind intubation using AMBU as the guide for the endotracheal tube was associated with better parameters than in the case of intubation using MAC, with respect to both intubation time (32 s [IQR; 22-45] and 47 s [IQR; 33-57], respectively; p = 0.017), effectiveness of the first intubation trial (33.9% and 5.4%, p = 0.002), as well as the total effectiveness of intubation (73.2% and 46.2%, p < 0.001). Conclusions: In our study, blind endotracheal intubation using AMBU was associated with more effective endotracheal intubation than standard intubation using direct laryngoscopy, both when the chest compressions were interrupted for the time of intubation and in the case of intubation during uninterrupted chest compressions.

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Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation

Cited by 20 publications

References 8 publications

Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest

The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

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