Lukasz Szarpak

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.

A comparison of a traditional endotracheal tube versus Etview Sl in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial

Background:Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. Methods:ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. Results:The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5–22] sec, when compared to that of sETT at 21.5 [IQR, 20–25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5–24.5] sec (p < .001) and sETT was 27 [IQR, 24.5–31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19–25.5] sec for the ETView and 42.5 [IQR, 35–49.5] sec for sETT. Conclusions:In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion, and cuff block were all found to be shorter with the ETView. Trial Registration:clinicaltrials.gov Identifier: NCT02733536.

C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial

Introduction The aim of this study was to compare C‐MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions. Methods The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with < 5 years of medical experience participated in the study. The paramedics attempted to intubate manikins in 3 airway scenarios: normal airway without cervical immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C). Results Scenario A: Nearly all participants performed successful intubations with both MAC and C‐MAC on the first attempt (95.7% MAC vs. 100% C‐MAC), with similar intubation times (16.5 s MAC vs. 18 s C‐MAC). Scenario B: The results with C‐MAC were significantly better than those with MAC (p < 0.05) for the time of intubation (23 s MAC vs. 19 s C‐MAC), success of the first intubation attempt (88.6% MAC vs. 100% C‐MAC), Cormack‐Lehane grade, POGO score, severity of dental compression, device difficulty score, and preferred airway device. Scenario C: The results with C‐MAC were significantly better than those with MAC (p < 0.05) for all the analysed variables: success of the first attempt (51.4% MAC vs. 100% C‐MAC), overall success rate, intubation time (27 s MAC vs. 20.5 s C‐MAC), Cormack‐Lehane grade, POGO score, dental compression, device difficulty score and the preferred airway device. Conclusion The C‐MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.

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.

Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data

Sir, The ability to perform airway management and maintain adequate ventilation of the patient are the key elements during cardiopulmonary resuscitation. Current European Resuscitation Council guidelines indicate the endotracheal intubation are the gold standard for airway control in adults during CPR [1]. However, as indicated by numerous scientific studies, the effectiveness of endotracheal intubation with direct laryngoscopy performed during resuscitation is inadequate [2,3, 4]. Therefore, it seems reasonable to search for alternative methods of endotracheal intubation, which are likely to increase the intubation effectiveness and reduce the total time of the procedure. The aim of the study was to compare two methods of endotracheal intubation performed by novice physicians during simulated CPR. Before the study, all the participants took part in a 10-minute training on the correct use of Trachway video intubating stylet (TVI, TVI4000, Markstein Sichtec Medical Corp., Taichung, Taiwan) and Macintosh laryngoscope (MACMercuryMedical, Clearwater, FL, USA). Intubation was performed on MegaCode KellyTM advanced life support manikin (Laerdal Medical, Stavanger, Norway), which was situated on a flat floor in a bright room. Intubation was performed during uninterrupted chest compressions. Due to the fact that the quality of chest compressions varies among medical staff [5,6], in order to standardize the difficulties arising from intubation duringuninterrupted chest compressions we used mechanical chest compression device Lifeline ARM (Defibtech, USA). In the main study, both the order of participants and the study methods were random. Participants had up to three endotracheal intubation attempts, after the procedure had a 10-minute break, and then performed endotracheal intubation using other method. The

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 comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study

Introduction: Pediatric cardiac arrest is an uncommon but critical life‐threatening event requiring effective cardiopulmonary resuscitation. High‐quality cardio‐pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two‐thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist‐clenched. This technique might facilitate adequate chest‐compression depth, chest‐compression rate and rate of full chest‐pressure relief. Methods: 42 paramedics from the national Emergency Medical Service of Poland performed three single‐rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two‐thumb (TTHT), the conventional two‐finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10‐seconds cycle. Results: The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p < 0.001), TFT and TTHT (p = 0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p < 0.001), and 9.5 mmHg for TTHT (p < 0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p < 0.001), nTTT and TTEHT (p < 0.001), and TFT and TTHT (p < 0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p = 0.025), TFT and nTTT (p < 0.001), as well as between TTHT and nTTT (p < 0.001) were statistically significant. Conclusions: The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.

Comparison of Macintosh and Intubrite laryngoscopes for intubation performed by novice physicians in a difficult airway scenario

Introduction: In the difficult airway, the intubation skills are critically important. In selected cases, particularly in airway edema, laryngeal or tongue edema, endotracheal intubation can turn out very difficult, and repeated attempts may even worsen the airway edema, causing trauma and bleeding, and finally leading to complete airway obstruction and inability to ventilate the patient. Aim of the study: The aim of the study was to compare the efficacy of endotracheal intubation performed by novice physicians using a standard Macintosh laryngoscope and an Intubrite videolaryngoscope. Material and methods: The study was designed as a prospective, randomized, crossover, simulation study and continues our research assessing the effectiveness of selected endotracheal intubation techniques in prehospital settings. All participants were experienced with the Macintosh direct laryngoscope but remained novice to videolaryngoscopy. Instructions on the correct use of the Macintosh and Intubrite laryngoscopes were given before the procedure, and all the 30 novice physicians were allowed to practice at least 10 times before the study on manikin with normal airways. We employed an airway manikin (Trucorp Airsim Bronchi; Trucorp Ltd., Belfast, Northern Ireland) to simulate difficult airway, with was obtained by inflating the tongue with 50 mL of air. The participants were asked to perform tracheal intubation using an endotracheal tube with 7.5 mm of internal diameter (Portex; Smiths Medical, Hythe, UK) through the vocal cords, applying either a conventional Macintosh laryngoscope with a size 3 blade (MAC; Mercury Medical, Clearwater, FL, USA) or the Intubrite videolaryngoscope, also with a Macintosh No. 3 blade (INT; Intubrite Llc, Vista, CA, USA). In both intubation techniques, a guide stylet (Rusch Inc., Duluth, GA, USA) was introduced into the endotracheal tube in order to obtain a C‐shape curve to facilitate tracheal intubation. Each participating physician was randomly assigned to three attempts of tracheal intubation with each device. Results: The effectiveness of the first intubation attempt using MAC and INT was 63.6% and 53.4%, respectively (p = 0.023), and the total percentage of intubation was 100% for both methods. The median time to intubation was 29.5 (interquartile range [IQR], 27–35.5) s with MAC, and 229 (IQR, 25.5–37) s with INT. The total of 24 physicians out of all study participants would choose MAC as a device to intubate with in real terms, while only 6 physicians would choose INT. Conclusions: During the simulation study, the novice physicians were able to perform endotracheal intubation at the same time using both the Macintosh and Intubrite videolaryngoscope. However, the efficacy of the first intubation attempt was higher for MAC. Further studies are needed to confirm the results.