A comparison of direct laryngoscopy to video laryngoscopy by paramedic students in manikin-simulated airway management scenarios

Abstract

IntroductionWe compare the effectiveness of direct laryngoscopy (DL) to video laryngoscopy (VL) in simulated, difficult airway scenarios in a cohort of novice, prehospital, emergency care providers.MethodsForty-five (45) students were randomised to DL or VL groups and then tasked to perform intubation on a manikin in three simulated airway scenarios. The scenarios included an uncomplicated intubation, intubation with manual in-line neck stabilisation (MILNS), and a simulated motor vehicle entrapment, with C-Spine held from behind, using a face-to-face intubation technique. The primary outcome was time taken to intubate, with secondary outcomes including first pass success rate, number of intubation attempts, Cormack-Lehane (CL) view grade obtained, adverse event rate, and self-reported laryngoscopist comfort.ResultsTwenty-seven participants (VL n = 15, DL n = 12) completed the study. Mean time to intubate was not statistically different between VL and DL groups in any scenario. VL was associated with an increased frequency of intubation attempts (p = 0.043) and failed intubations (RR 6.4, 95% CI 0.92–44.33, p = 0.0175) in the face-to-face intubation scenario, VL was associated with a reduced incidence of poor CL view (RR 0.06, 95% CI 0.004–0.997, p = 0.0497) in the face-to-face intubation scenario, and a reduction in the frequency of dental damage (RR 0.13, 95% CI 0.02–0.96, p = 0.0165) in the supine MILNS scenario.DiscussionIn our small sample, we found DL to be superior to VL in relation to a reduced risk of failed intubation and frequency of intubation attempts despite VL being superior in obtaining a good view of the vocal cords in a face-to-face intubation scenario. We found no statistically significant difference in the time taken to intubate in any scenarios. A larger study is required to inform practice and education around prehospital use of VL.

Endotracheal Intubation by Paramedics Using Neodymium Magnet and Modified Stylet in Simulated Difficult Airway: A Prospective, Randomized, Crossover Manikin Study

“…In a study conducted by Maartens et al involving paramedics as operators, the mean time for intubation was 39.33 s (95% confidence interval, 21.21–57.46) for DL and 50.93 s (95% confidence interval, 17.37–84.50) for VL on a model fitted with a cervical collar [5]. In a study conducted by Kim et al comparing the MAC laryngoscope and a custom-made ergonomic laryngoscope in an intubation model, the mean time to intubation was 49.7 ± 37.5 s for the MAC laryngoscope [21].…”

Perbandingan Angka Keberhasilan dan Lama Intubasi antara Metode Laringoskopi Direk dan Videolaringoskopi pada Pasien Obesitas

“…23 Waktu intubasi yang lebih lama dengan metode videolaringoskopi dibanding dengan metode laringoskopi direk ini disebabkan oleh proses penggunaan alat videolaringoskop yang membutuhkan koordinasi antara motorik tangan dan visualisasi yang didapat pada kamera. 14,[24][25][26][27] Selain koordinasi yang dibutuhkan, pada saat penggunaan videolaringoskop, operator yang lebih terbiasa menggunakan metode laringoskopi direk dibanding dengan metode videolaringoskopi mungkin memengaruhi waktu intubasi. 15 Faktor lain videolaringoskop adalah terdapat risiko buram akibat uap, sekret darah, atau muntah yang menghambat visualisasi kamera yang membutuhkan waktu penyesuaian visualisasi.…”

“…15 Faktor lain videolaringoskop adalah terdapat risiko buram akibat uap, sekret darah, atau muntah yang menghambat visualisasi kamera yang membutuhkan waktu penyesuaian visualisasi. 14,23,26,27 Hasil waktu intubasi yang lebih lama dengan metode videolaringoskopi pada penelitian ini selain tidak bermakna secara statistik, juga tidak relevan secara klinis karena saturasi arteri seluruh subjek penelitian ini selalu dalam keadaan baik (Tabel 4). Pada penelitian lain pun didapatkan hasil waktu intubasi yang sedikit lebih lama pada kelompok dengan metode videolaringoskopi dibanding dengan metode laringoskopi direk.…”