Comparison of Various Intubation Deviced During Resuscitation of Covid-19-Suspected Patients by Paramedics Wearing Personal Protective Equipment

Abstract

Background: Endotracheal intubation is one of the basic methods for airway control during cardiopulmonary resuscitation. In the era of the prevailing pandemic of SARS-CoV-2, medical personnel may face a necessity of resuscitating aninfected patient. Objective: The objective was to compare three intubation methods for suspected/confirmed COVID-19 adult patient resuscitation performed by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGP). Material and Methods: The multicentre, single-blind, prospective, randomized, crossover simulation trial involved 32 paramedics. The participants wearing PPE AGP performed tracheal intubations with the Macintosh, Airtraq, and McGrath MAC laryngoscopes in a patient with suspected COVID-19 in two resuscitation scenarios: scenario A-without chest compressions; scenario B-with continuous chest compressions. The primary outcome was time to intubation. Results: In scenario A, the intubation time for the respective devices equalled 35 s (IQR: 29-46) vs. 44s (IQR: 35-67) vs. 49 (IQR: 34-72) (p = 0.003). The total efficacy of each intubation method was 100%; however, the efficacy of the first intubation attempt was highest for McGrath MAC (90.6%), followed by Macintosh (68.1%) and Airtraq 62.5%) (p<0.001). In scenario B, the results with McGrath MAC were significantly better than those with Macintosh and Airtraq(p<0.05) for all the analysed variables. Conclusions: In conclusion, the McGrath MAC videolaryngoscope offers better intubation conditions as compared with the Macintosh laryngoscope or Airtraq in the resuscitation COVID-19.

A retrospective survey study of paramedic students’ exposure to SARS-CoV-2, participation in the COVID-19 pandemic response, and health-related quality of life

“…Our results show that six students (15.0%) participated in AGPs without adequate PPE while performing patient-related healthcare work, and three students (15%) participated in AGPs without adequate PPE while in study-related clinical placements in the ambulance service. COVID-19 patients may need supplemental oxygen therapy, and sometimes non-invasive or invasive ventilator support [ 7 , 8 , 39 ]. In Norway, ambulance personnel perform AGPs such as continuous positive airway pressure (CPAP) and invasive airway interventions such as extraglottic airway devices and endotracheal intubations.…”

“…In Norway, ambulance personnel perform AGPs such as continuous positive airway pressure (CPAP) and invasive airway interventions such as extraglottic airway devices and endotracheal intubations. AGPs are known to constitute a risk to personnel in the proximity [ 8 , 9 , 40 ]. These numbers indicate that students were exposed to COVID-19 through emergency work in and outside the ambulance service.…”

“…Several studies of COVID-19 patients with respiratory failure acknowledge that paramedics in a prehospital setting are a valuable resource for evaluating and treating COVID-19 patients [ 8 , 9 ], Consequently, paramedics are valuable healthcare workers during the COVID-19 pandemic, but they need to take precautions and use PPE whenever they suspect COVID-19 in patients, often in a time-critical phase.…”