Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study

Pantazopoulos, Ioannis; Kolonia, Konstantina; Laou, Eleni; Mermiri, Maria; Tsolaki, Vasiliki; Koutsovasilis, Anastasios; Zakynthinos, George E.; Gourgoulianis, Konstantinos; Αrnaoutoglou, Eleni; Chalkias, Athanasios

doi:10.1016/j.jemermed.2021.01.001

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…It is worth noting, however, that unlike our study (where paramedics alone participated), the Taylor et al study included mostly emergency medicine residents. In the study by Pantazopoulos et al [31] 70 inexperienced physicians showed that first-pass ISR and IT with the McGrath MAC video laryngoscope was not affected by PPE donning which is also confirmed by the results of our study. However, in the study by Pantazopoulos et al as in our study, a negative effect of intubation with the PPE-AGP suit was observed on the firstpass ISR, the total ISR as well as the IT performed with the Macintosh direct laryngoscope.…”

Section: Discussionsupporting

confidence: 90%

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Gadek¹,

Szarpak

Konge

et al. 2021

JCM

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A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

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Section: Discussionsupporting

confidence: 90%

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Gadek¹,

Szarpak

Konge

et al. 2021

JCM

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“…1-4 1a Videolaryngoscopy can increase first-pass intubation success, 17,19 reduce failures, 19 increase the distance between the intubator and the patient's airway 20 and mitigate some of the impediments posed by personal protective equipment. 21 Use of a videolaryngoscope with a screen discrete from the blade is associated with improved teamwork, communication and 'flattening of the hierarchy' within the intubating team. 22 The videolaryngoscope has changed from being primarily an airway rescue device to being increasingly advocated as the first-choice device in more recent guidelines.…”

Section: Increased Use Of Videolaryngoscopesmentioning

confidence: 99%

Practical strategies for delivering airway training in the COVID-19 era

Hickman

McNarry

Kelly

2021

British Journal of Anaesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Over time, wearing PPE because of the COVID-19 pandemic has led to a greater preference for video laryngoscopy over direct laryngoscopy among emergency physicians. [5][6][7] Due to the COVID-19 pandemic, pre-emptive screening and isolation rooms are used in all emergency centers, making it difficult to accommodate critically ill patients. In addition, since it is necessary to perform tracheal intubation while wearing PPE, there is a high possibility that delayed intubation and intubation failure will occur, and experienced physicians often perform the intubations.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, the chances of being satisfied with the intubation experience when an inexperienced physician is involved have diminished. [5][6][7] In other words, the factor that guarantees skill level in airway management is the level of experience with successful intubation [8] ; however, the COVID-19 pandemic makes it difficult to provide an adequate number of intubation experiences for novice practitioners.…”

Section: Introductionmentioning

confidence: 99%

Educational suitability of new channel-type video-laryngoscope with AI-based glottis guidance system for novices wearing personal-protective-equipment

et al. 2022

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The aim of this study was to determine which of 4 laryngoscopes, including A-LRYNGO, a newly developed channel-type videolaryngoscope with an embedded artificial intelligence-based glottis guidance system, is appropriate for tracheal intubation training in novice medical students wearing personal protective equipment (PPE).Thirty healthy senior medical school student volunteers were recruited. The participants underwent 2 tests with 4 laryngoscopes: Macintosh, McGrath, Pentax Airway-Scope and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshop. The second test was conducted after a one-on-one hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc, and asked all participants to complete a short questionnaire.The time to completely insert the endotracheal tube with the Macintosh laryngoscope did not change significantly (P = .177), but the remaining outcomes significantly improved after the hands-on workshop (all P < .05). Despite being novice practitioners with no intubation experience and wearing PPE, the, 2 channel-type video-laryngoscopes were associated with good intubation-related performance before the hands-on workshop (all P < .001). A-LRYNGO's artificial intelligence-based glottis guidance system showed 93.1% accuracy, but 20.7% of trials were guided by the vocal folds.To prepare to manage the airway of critically ill patients during the coronavirus disease 2019 pandemic, a channel-type videolaryngoscope is appropriate for tracheal intubation training for novice practitioners wearing PPE.Abbreviations: AWS = pentax airway scope, C-L grade = cormack-lehane grade, COVID-19 = coronavirus disease 2019, IVT = the interval from the blade of each laryngoscope passing the incisor to visualization of the glottis, PPE = personal protective equipment, VFT = the interval from visualization of the glottis to endotracheal tube insertion completion with removal of the laryngoscope.

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Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study

Cited by 9 publications

References 25 publications

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Practical strategies for delivering airway training in the COVID-19 era

Educational suitability of new channel-type video-laryngoscope with AI-based glottis guidance system for novices wearing personal-protective-equipment

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