Endotracheal intubation with a video-assisted semi-rigid fiberoptic stylet by prehospital providers

Abstract

BackgroundEmergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS).MethodsALS EMTs were first shown a brief slideshow and three example videos and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed on the floor to simulate field intubation at the scene. Each participant was given up to three timed attempts with each technique. Endotracheal tube position was confirmed with visualization by one of the study authors. Comparisons and statistical analysis were conducted using SPSS® Statistics 21 (IBM®). Demographics and survey results were also collected and analyzed.ResultsThe median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997). Demographic factors including handedness and eye dominance did not seem to affect outcomes. Participants reported a relatively high level of satisfaction with the CVS.ConclusionsALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device. The CVS technique warrants further study for use as an alternative to DL and video laryngoscopy in the prehospital difficult airway scenario.

A comparative evaluation of Video Stylet and flexible fibre-optic bronchoscope in the performance of intubation in adult patients

“…Another explanation may be that the length of the insertion cord of FO bronchoscope is longer than stylet's length, consuming more time while railroading ETT. Previous studies with OptiScope™ which is a rigid VS had a median intubation time range of 15 (12–19) s,[ 4 ] and other study used Clarus™ Video System to intubate simulation airway had a median duration of intubation of 15.5 s[ 5 ] that are comparable to our study (19.7 s). The time of intubation in both the cases was taken from the insertion of device into the mouth till the removal of stylet; this could be the reason for a longer duration of intubation in our study as we took intubation time till the appearance of capnograph.…”

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%.…”

The Clarus Video System (Trachway) and direct laryngoscope for endotracheal intubation with cricoid pressure in simulated rapid sequence induction intubation: a prospective randomized controlled trial

“…Intubating stylets with a slim handle have been proved to be superior to laryngoscopic devices for the endotracheal intubation in terms of ease of movement [7, 8] and prevention of dental injury [8]. The Clarus Video System (Trachway®, CVS) intubating stylet (Biotronic Instrument Enterprise Ltd., Tai-Chung, Taiwan), a video stylet, has been proved to be a comparable but faster solution to successful intubation than DL [9–11] in intubation without CP. Moreover, the CVS can also be operated as a lightwand when its red light is turned on.…”