Paramedic Laryngoscopy in the Simulated Difficult Airway: Comparison of the Venner A.P. Advance and GlideScope Ranger Video Laryngoscopes

Abstract

Objectives: This study assesses intubation times and potential trauma with two new portable video laryngoscopes, the GlideScope Ranger (GSR) and the Venner A.P. Advance (APA), in a simulated difficult prehospital airway. The GSR has a hockey stick shape and is inserted by a different (midline) technique compared with direct laryngoscopy and requires the use of a stylet. The APA has a handle similar to a direct laryngoscope, but with an angulated difficult airway blade. The APA is designed to have an intuitive insertion technique somewhat similar to that of direct laryngoscopy (lateral tongue displacement) and has a guiding mechanism that foregoes the need for a stylet.Methods: Thirty qualified paramedics received a short demonstration of each device and were asked to intubate a modified Grade III difficult laryngoscopy mannequin in a random order (closed envelope technique). Optimal view and tracheal intubation times were recorded, and potential trauma assessed by the number of additional discrete forward advances and by visual analog scale (VAS). Direct laryngoscopy was used as a comparator. The Wilcoxon rank sum test was used for intubation times, optimal view times, percentage of glottis opening (POGO) seen, and objective trauma assessment. Student's paired ttest was used for subjective trauma assessment and a Bonferroni correction was used for the primary outcome measures.Results: Participants declared a median of 60 (range 20 to 300) previous intubations. Time to achieve optimal view between APA and GSR was not different (20 seconds vs. 19 seconds; p = 0.19), but tracheal intubation was significantly faster with the APA (25 seconds vs. 46 seconds; p < 0.0001). Intubation success was ultimately 97% in both groups. Participants judged subjective trauma to be less for the APA than GSR on a VAS (1.6 cm vs. 3.3 cm; p < 0.001). More than three additional forward advances were required in 43% of GSR and 0% of APA intubations.

Mobile Mixed Reality for Experiential Learning and Simulation in Medical and Health Sciences Education

“…In particular, airways management education and hands-on training is essential [29] and changes attitudes and behavior for all health professionals [30]. This is especially true for trainee surgeons or paramedics studying high-priority invasive skills, such as direct laryngoscopy with foreign body removal in pre-emergency care [31], where students require confidence and experience to execute skills correctly. Physical task simulation trainers (manikins) are an ideal setting for novice learners to train these important hands-on airways skills, as they isolate specific tasks to enhance procedural or surgical techniques using three-dimensional (3D) parts of the body or limb to represent a part of the whole [32].…”

Comparison of Success Rates between Two Video Laryngoscope Systems Used in a Prehospital Clinical Trial

“…[1][2][3][4][5][6][7][8][9] The success rate for difficult airway scenarios in this setting (e.g., c-collar, manikin positioning, chest compressions) varies between 50 and 100%, which is higher than the success rates reported for direct laryngoscopy in each of these studies. [1][2][3][4][5]7,8 A recently published simulated difficult airway study examining the use of 5 different airway devices, including video laryngoscopes, showed no difference in placement success rates between video laryngoscope systems and direct laryngoscopy. 10 Time to airway placement for EMS providers has not been shown to be consistently faster with VL.…”

A review of the literature: direct and video laryngoscopy with simulation as educational intervention

“…In another study, there was a 13-second median difference during the first successful attempt (DL, 23 seconds versus VL 36 seconds, P =0.01) 26. The majority of the studies (57%) did not find significant differences in intubation success rates in DL and VL procedures 18–21…”