Lukasz Czyzewski

Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?: A Randomized Crossover Manikin Study.

AbstractThe aim of this study was to assess the performance of the ETView VivaSight SL (ETView) single-lumen airway tube with an integrated high-resolution imaging camera in a manikin-simulated cardiopulmonary resuscitation scenario with and without chest compression.This was a randomized crossover manikin trial. Following a brief training session, 107 volunteer novice physicians who were inexperienced with airway management attempted to intubate a manikin using a Macintosh laryngoscope (MAC) and an ETView, with and without chest compressions. The participants were instructed to make 3 attempts in each scenario. In this trial, we compared intubation time, intubation success rates, and glottic visibility using a Cormack & Lehane Grade. Dental compression and ease of use of each device were also assessed.Median intubation times for the ETView and MAC without chest compressions were 17 (IQR, 15–19) s and 27 (IQR, 25–33) s, respectively (P < 0.001). The ETView proved more successful on the first intubation attempt than the MAC, regardless of compressions. Continuation of compressions caused an increase in intubation times for both the ETView (P = 0.27) and the MAC (P < 0.005).The ETView VivaSight SL is an effective tool for endotracheal intubation when used by novice physicians in a manikin-simulated cardiac arrest, both with and without chest compressions.Trial Registration: clinicaltrials.gov Identifier: NCT02295618.

Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial ☆ ☆☆ ★

BACKGROUD Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR. METHODS One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation. RESULTS The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively. CONCLUSIONS Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.

A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study.

INTRODUCTION Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin. METHODS This was an open, prospective, randomized, crossover, manikin trial involving 95 paramedics who performed intubations in a PediaSIM pediatric high-fidelity manikin with Macintosh and McGrath laryngoscopes, with and without concomitant mechanical CCs. Primary outcome was the TTI, and secondary outcome was success of the attempt. Participants rated their best glottic view, the severity of the potential dental trauma, and subjective opinion about the difficulty of the procedure. RESULTS The median TTI with the Macintosh in the scenario with uninterrupted CC was 33 (interquartile range [IQR], 24-36) seconds, which is significantly longer than TTI in the scenario with interrupted CC (23 [IQR, 20-29] seconds, P < .001). Time to intubation using the McGrath was similar in both scenarios: 20 (IQR, 17-23) seconds vs 19.5 (IQR, 17-22) seconds (P = .083). A statistically significant difference between McGrath and Macintosh was noticed in TTI both in scenario with (P < .001) and without CC (P = .017). CONCLUSIONS McGrath video laryngoscope helps paramedics to intubate a pediatric manikin in a CPR scenario in less time and with fewer attempts than with the classical Macintosh, both in case of ongoing or stopped CC. McGrath use in actual patients could improve CPR quality by paramedics.

Can GlideScope® videolaryngoscope be an alternative to direct laryngoscopy for child and infant tracheal intubation during chest compression?

In the article from Rodriguez-Nunez et al. entitled “Tracheal intubation of pediatric manikins during ongoing chest compressions. Does GlideScope® videolaryngoscope improve pediatric residents’ performance?” [1], the authors conducted a study on the time taken to intubate children and infants using the GlideScope and Miller (MIL) laryngoscopes. Due to the small number of participants in the aforementioned trial and a lack of data concerning the effectiveness of individual attempts at endotracheal intubation (ETI), decided decision was made to conduct extended research on intubation using the GlideScope and Miller Laryngoscopes.

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

BACKGROUND Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. METHODS This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. RESULTS Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)). CONCLUSIONS During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

A Randomized Cadaver Study Comparing First-Attempt Success Between Tibial and Humeral Intraosseous Insertions Using NIO Device by Paramedics: A Preliminary Investigation.

Abstract Medical personnel may encounter difficulties in obtaining intravenous (IV) access during cardiac arrest. The 2015 American Heart Association guidelines and the 2015 European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) suggest that rescuers establish intraosseous (IO) access if an IV line is not easily obtainable. The aim of the study was to compare the success rates of the IO proximal tibia and proximal humerus head access performed by paramedics using the New Intraosseous access device (NIO; Persys Medical, Houston, TX, USA) in an adult cadaver model during simulated CPR. In an interventional, randomized, crossover, single-center cadaver study, a semi-automatic spring-load driven NIO access device was investigated. In total, 84 paramedics with less than 5-year experience in Emergency Medical Service participated in the study. The trial was performed on 42 adult cadavers. In each cadaver, 2 IO accesses to the humerus head, and 2 IO accesses to the proximal tibia were obtained. The success rate of the first IO attempt was 89.3% (75/84) for tibial access, and 73.8% (62/84) for humeral access (P = 0.017). The procedure times were significantly faster for tibial access [16.8 (interquartile range, IQR, 15.1–19.9] s] than humeral access [26.7 (IQR, 22.1–30.9) s] (P < 0.001). Tibial IO access is easier and faster to put in place than humeral IO access. Humeral IO access can be an alternative method to tibial IO access. Trial Registration: clinicaltrials.gov Identifier: NCT02700867.

Ability of paramedics to perform endotracheal intubation during continuous chest compressions: a randomized cadaver study comparing Pentax AWS and Macintosh laryngoscopes☆☆☆★

OBJECTIVE The aim of the trial was to compare the time parameters for intubation with the use of the Macintosh (MAC) laryngoscope and Pentax AWS-S100 videolaryngoscope (AWS; Pentax Corporation, Tokyo, Japan) with and without chest compression (CC) by paramedics during simulated cardiopulmonary resuscitation in a cadaver model. METHODS This was a randomized crossover cadaver trial. Thirty-five paramedics with no experience in videolaryngoscopy participated in the study. They performed intubation in two emergency scenarios: scenario A, normal airway without CC; scenario B, normal airway with continuous CC. RESULTS The median time to first ventilation with the use of the AWS and the MAC was similar in scenario A: 25 (IQR, 22-27) seconds vs. 24 (IQR, 22.5-26) seconds (P=.072). A statistically significant difference in TTFV between AWS and MAC was noticed in scenario B (P=.011). In scenario A, the first endotracheal intubation (ETI) attempt success rate was achieved in 97.1% with AWS compared with 94.3% with MAC (P=.43). In scenario B, the success rate after the first ETI attempt with the use of the different intubation methods varied and amounted to 88.6% vs. 77.1% for AWS and MAC, respectively (P=.002). CONCLUSIONS The Pentax AWS offered a superior glottic view as compared with the MAC laryngoscope, which was associated with a higher intubation rate and a shorter intubation time during an uninterrupted CC scenario. However, in the scenario without CC, the results for AWS and MAC were comparable.

Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial.

INTRODUCTION The main cause of cardiac arrest in pediatric patients is respiratory failure. OBJECTIVE To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios. METHODS This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC. RESULTS A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P=.73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P=.67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC (P<.05) for all analyzed variables. CONCLUSIONS This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.

CPR using the lifeline ARM mechanical chest compression device: a randomized, crossover, manikin trial☆

Introduction: European Resuscitation Council as well as American Heart Association guidelines for cardiopulmonary resuscitation (CPR) stress the importance of uninterrupted and effective chest compressions (CCs). Manual CPR decreases in quality of CCs over time because of fatigue which impacts outcome. We report the first study with the Lifeline ARM automated CC device for providing uninterrupted CCs. Methods: Seventy‐eight paramedics participated in this randomized, crossover, manikin trial. We compared the fraction of effective CCs between manual CPR and automated CPR using the ARM. Results: Using the ARM during resuscitation resulted in a higher percentage of effective CCs (100/min [interquartile range, 99‐100]) compared with manual CCs (43/min [interquartile range, 39‐46]; P < .001). The number of effective CCs decreased less over time with the ARM (P < .001), more often reached the required depth of 5 cm (97% vs 63%, P < .001), and more often reached the recommended CC rate (P < .001). The median tidal volume was higher and hands‐off time was lower when using the ARM. Conclusion: Mechanical CCs in our study adhere more closely to current guidelines than manual CCs. The Lifeline ARM provides more effective CCs, more ventilation time and minute volume, less hands‐off time, and less decrease in effective CCs over time compared with manual Basic Life Support and might therefore impact outcome.

COMPARISON OF ENDOTRACHEAL INTUBATION WITH THE AIRTRAQ AVANT® AND THE MACINTOSH LARYNGOSCOPE DURING INTERMITTENT OR CONTINUOUS CHEST COMPRESSION: A RANDOMIZED, CROSSOVER STUDY IN MANIKINS

BACKGROUND: Endotracheal intubation (ETI) currently is the gold standard of securing an airway during cardio- pulmonary resuscitation. PURPOSE: The aim of this study was to evaluate ETI with the Airtraq Avant (ATQ) compared to a conventional Macintosh laryngoscope when used by paramedics during resuscitation with and without chest compression (CC). METHODS: Forty-seven paramedics were recruited into a randomized crossover trial in which each performed ETI with ATQ and MAC in both scenarios. The primary endpoint was time to successful intubation, while secondary endpoints included intubation success, laryngoscopic view on the glottis, dental compression, and rating of the given device. RESULTS: In the manikin scenario without CC, nearly all participants performed ETI successfully both with ATQ and MAC, with a shorter intubation time using MAC 20.5 s [IQR, 17.5–22], compared to ATQ 24.5 s [IQR, 22–27.5] (p = 0.002). However, in the scenarios with continuous CC, the results with ATQ were signi cantly better than with MAC for all analyzed variables (success of rst attempt at ETI, time to intubation (TTI) [MAC 27 s [IQR, 25.5–34.5], compared to ATQ 25.7s [IQR, 21.5–28.5] (p=0.011), Cormack-Lehane grade and rating). The success rate in scenarios with CC was 82.9% vs. 91.5% for MAC Laryngoscope vs. ATQ, respectively (p=0.021). CONCLUSIONS: The ATQ provides bene ts in terms of ETI success rate, TTI, and glottic view when compared to MAC during ETI with continuous CC.