Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial

Abstract

Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-viewTM VL, UESCOPE® VL, ProVu® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. Results: The longest IT was noted when the UESCOPE® (29.4 s) and ProVu® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu®, UESCOPE® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE® and ProVu®. Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE® and ProVu® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.

Comparison of Macintosh Laryngoscope, King Vision®, VividTrac®, AirAngel Blade®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices—A Non-Inferiority Trial

“…Recent studies on the DL vs. VL technique among novice users have presented inconsistent findings on the superiority of one technique over the other, but improved time metrics and glottic visualization with VLs have been observed, especially in the difficult airway scenario, which is in concordance with our study. Our findings also support previously described similar success rates of the two techniques and the questionable advantage of non-channeled devices for novice operators [ 43 , 44 , 45 , 46 ].…”

“…The study of Kluj. et al compared three non-channeled VLs and the Macintosh DL in a simulated environment where PPE-wearing novice users had to execute the intubation, and they could not prove that VLs presented a significant advantage regarding first pass success rates and intubation times [ 43 ]. A recent study of Muhamed et al—evaluating a similar number of novices as our study—found that the evaluated VL performed better in terms of time-related metrics, glottic visualization, and incidence of dental injury, but it showed similar results when it came to success rates and ease of use [ 44 ].…”

Current trends in emergency airway management: a clinical review

“…Throughout the coronavirus disease-19 (COVID-19) pandemic, more studies have evaluated laryngoscopes because the necessity of wearing personal protective equipment (PPE) for aerosolgenerating procedures has resulted in a change in ETI protocols for safety [31,39]. PPE plays an important role in preventing the spread of disease, however, previous studies suggested that PPE may reduce the effectiveness of ETI [31,40].…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…[148,149]. It is also noticed that the tracheal intubation procedure might be hampered by the personal protective equipment [150][151][152][153].…”