Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Abstract

Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators

“…Case reports have suggested that the flexible tip of a videobronchoscope (fiberscope) can prevent ETT impingement on the trachea [ 14 , 15 ], and a prospective clinical trial showed that a flexible tip ETI (fiberscope) was superior to a preshaped stylet [ 6 ]. A comparison of the FROVA and the FTB with experienced intubators using the GlideScope showed faster and easier intubation with the FTB [ 7 ], and another manikin study using a MacIntosh laryngoscope showed superiority of the FTB during simulated cardiac arrest [ 16 ]. The FTB provides a cheaper, accessible alternative to the fiberscope, requiring only one intubator.…”

“…Sharma outlined the limitations of GlideScope "intubation" as opposed to "laryngoscopy", suggesting that the two should be considered separately [19]. Previous comparative manikin studies include laryngoscopy time, measuring the time the blade enters the mouth until the ETT is fully inserted [12,16,20]. By excluding laryngoscopy and providing a static, constant view of the larynx, we provided the same view for each participant in both arms of the crossover study.…”

Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis

“…The nine remaining studies had their reference lists screened and a further four studies were identified and included. A total of 13 studies were therefore included in our qualitative synthesis [14][15][16][17][18][19][20][21][22][23][24][25][26]. Of these studies, 10 were included in our quantitative synthesis [14,15,[19][20][21][22][23][24][25][26].…”

“…A total of 13 studies were therefore included in our qualitative synthesis [14][15][16][17][18][19][20][21][22][23][24][25][26]. Of these studies, 10 were included in our quantitative synthesis [14,15,[19][20][21][22][23][24][25][26]. This study selection process has been summarised in a PRISMA flow chart (Fig.…”

“…Every study had at least 7% of criteria answered "CD/NA/NR" as every study investigated an exposure that could not vary in amount or level. Eight studies had 14% of criteria answered "CD/NA/ NR" [17][18][19][22][23][24][25][26] as it could not be determined whether the participation rate of eligible persons was at least 50%.…”