ET-View compared to direct laryngoscopy in patients with immobilized cervical spine by unexperienced physicians: A randomized crossover manikin trial

Abstract

Background: Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. Although the ET-View is essentially a conventional endotracheal tube, it is equipped with a miniature camera in its tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by inexperienced physicians. Methods: This was a prospective, randomized, cross-over manikin trial. Fifty novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. The overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack and Lehane classification were assessed. Results: All physicians were able to intubate the manikin in all scenarios using the ET-View, whereas direct laryngoscopy failed in 16% with immobilized cervical spine using the patriot cervical extraction collar. The first intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy. Conclusion:The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings.

Endotracheal tube-mounted camera-assisted intubation versus conventional intubation in intensive care: a prospective, randomised trial (VivaITN)

“…Thus far, the VST has shown promising results for endotracheal intubation via supraglottic airway devices [ 11 , 17 ], in mannikins [ 18 – 22 ] and in a cadaver study [ 23 ]. Furthermore, the guidance of percutaneous dilatational tracheostomy by VST has been evaluated and shown to be feasible [ 24 , 25 ].…”

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

“…The above tendency concerned both the total meta-analysis outcome and subgroup analysis, particularly intubation under normal airway, cervical spine immobilisation with cervical collar, or continuous chest compression scenarios. In the case of the overall success rate of intubation, Karczewska et al demonstrated that intubators were able to intubate patients with a 100% success rate for both VivaSight and direct laryngoscope under cervical spine immobilisation with a vacuum mattress [13]. 100% effectiveness of intubation with the discussed methods was also observed by Gawłowski et al in the cervical spine man-fIGuRe 6.…”

“…4). The analysis in subgroups showed that the above trend was observed in each subgroup [13] assessed intubation in cervical spine immobilisation with a vacuum mattress scenario and also showed the advantage of VivaSight over DL (90% vs. 60%; RR = 1.50 [1.17, 1.92]; p = 0.001). In contrast, the Truszewski et al [20] study showed the advantage of…”

Comparison of endotracheal intubation learning curves with tracheoscopic ventilation tube for simulated difficult intubation between expert and novice anesthesiologists.

“…Even though we included novice residents, their failure rate reached only 6.9%. According to the manikin study [17], when they applied cervical collars to the manikins, all of their CL grades were II and III, and the intubation success rate reached 100% with TVT compared to 84% with direct laryngoscopy. These results imply that endotracheal intubation with TVT under assist of direct laryngoscopy provides easier intubation conditions and a higher success rate.…”