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Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment

  • Sami Yousif (a1) (a2), Jason T. Machan (a3) (a4) (a5), Yasser Alaska (a6) and Selim Suner (a4) (a7)

Abstract

Introduction

Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control.

Hypothesis/Problem

The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.

Methods

In this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device.

Results

A total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons).

Conclusion

Use of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use.

Yousif S , Machan JT , Alaska Y , Suner S . Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment. Prehosp Disaster Med. 2017;32(4):352356.

Copyright

Corresponding author

Correspondence: Sami Yousif, MBBS, SBEM Emergency Medicine Department King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center P.O. Box 22490 Riyadh 11426 Saudi Arabia E-mail: dr_sami911@yahoo.com

Footnotes

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Conflicts of interest: none

Footnotes

References

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1. Talmor, D. Airway management during a mass-casualty event. Respir Care. 2008;53(2):226-231; discussion 231.
2. Nozaki, H, Hori, S, Shinozawa, Y, et al. Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med. 1995;21(12):1032-1035.
3. Fowler, RA, Guest, CB, Lapinsky, SE, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Car Med. 2004;169(11):1198-1202.
4. Brinker, A, Gray, SA, Schumacher, J. Influence of air-purifying respirators on the simulated first response emergency treatment of CBRN victims. Resuscitation. 2007;74(2):310-316.
5. Coates, MJ, Jundi, AS, James, MR. Chemical protective clothing; a study into the ability of staff to perform lifesaving procedures. J Accid Emerg Med. 2000;17(2):115-118.
6. Castle, N, Owen, R, Hann, M, Clark, S, Reeves, D, Gurney, I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low- and high-dexterity airway and vascular access skills. Resuscitation. 2009;80(11):1290-1295.
7. Flaishon, R, Sotman, A, Ben-Abraham, R, Rudick, V, Varssano, D, Weinbroum, AA. Antichemical protective gear prolongs time to successful airway management: a randomized, crossover study in humans. Anesthesiology. 2004;100(2):260-266.
8. Hendler, I, Nahtomi, O, Segal, E, Perel, A, Wiener, M, Meyerovitch, J. The effect of full protective gear on intubation performance by hospital medical personnel. Mil Med. 2000;165(4):272-274.
9. Goldik, Z, Bornstein, J, Eden, A, Ben-Abraham, R. Airway management by physicians wearing anti-chemical warfare gear: comparison between laryngeal mask airway and endotracheal intubation. Eur J Aaesthesiol. 2002;19(3):166-169.
10. Castle, N, Owen, R, Hann, M, Clark, S, Reeves, D, Gurney, I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low- and high-dexterity airway and vascular access skills. Resuscitation. 2009;80(11):1290-1295.
11. Noppens, RR. Airway management in the intensive care unit. Acta Clinica Croatica. 2012;51(3):511-517.
12. Sakles, JC, Mosier, JM, Chiu, S, Keim, SM. Tracheal intubation in the emergency department: a comparison of GlideScope video laryngoscopy to direct laryngoscopy in 822 intubations. J Emerg Med. 2012;42(4):400-405.
13. Pirlich, N, Piepho, T, Gervais, H, Noppens, RR. [Indirect laryngoscopy/video laryngoscopy. A review of devices used in emergency and intensive care medicine in Germany]. Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2012;107(7):521-530.
14. Bjoernsen, LP, Lindsay, B. Video laryngoscopy in the prehospital setting. Prehosp Disaster Med. 2009;24(3):265-270.
15. Greenland, KB, Brown, AF. Evolving role of video laryngoscopy for airway management in the emergency department. Emerg Med Australas. 2011;23(5):521-524.
16. Maharaj, CH, Costello, JF, Higgins, BD, Harte, BH, Laffey, JG. Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia. 2006;61(7):671-677.
17. Griesdale, DE, Liu, D, McKinney, J, Choi, PT. GlideScope video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anaesth. 2012;59(1):41-52.
18. Nasim, S, Maharaj, CH, Malik, MA, Higgins, J OD, Laffey, BD, , JG. Comparison of the GlideScope and Pentax AWS laryngoscopes to the Macintosh laryngoscope for use by advanced paramedics in easy and simulated difficult intubation. BMC Emerg Med. 2009;9:9.
19. Maharaj, CH, McDonnell, JG, Harte, BH, Laffey, JG. A comparison of direct and indirect laryngoscopes and the ILMA in novice users: a manikin study. Anaesthesia. 2007;62(11):1161-1166.
20. Wang, HE, Szydlo, D, Stouffer, JA, et al. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation. 2012;83(9):1061-1066.
21. Tanabe, S, Ogawa, T, Akahane, M, et al. Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study. J Emerg Med. 2013;44(2):389-397.
22. Burns, JB Jr., Branson, R, Barnes, SL, Tsuei, BJ. Emergency airway placement by EMS providers: comparison between the King LT supralaryngeal airway and endotracheal intubation. Prehosp Disaster Med. 2010;25(1):92-95.
23. Teoh, WH, Shah, MK, Sia, AT. Randomized comparison of Pentax AirwayScope and GlideScope for tracheal intubation in patients with normal airway anatomy. Anaesthesia. 2009;64(10):1125-1129.
24. Kaki, AM, Almarakbi, WA, Fawzi, HM, Boker, AM. Use of Airtraq, C-Mac, and GlideScope laryngoscope is better than Macintosh in novice medical students’ hands: A manikin study. Saudi J Anaesth. 2011;5(4):376-381.

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