Truview EVO2 and Standard Macintosh Laryngoscope for Tracheal Intubation During Cardiopulmonary Resuscitation

Abstract

The aim of this study was to compare the performance of the Truview EVO2 laryngoscope in manikin-simulated cardiopulmonary resuscitation (CPR) and no-CPR scenarios with standard intubation technique.Participants performed 4 scenarios in random order: endotracheal intubation (ETI) using Macintosh laryngoscope (MCL), Truview EVO2 laryngoscope in no-CPR patient scenario, and intubation during uninterrupted chest compressions using both laryngoscopes. The participants were directed to make 3 attempts in each scenario. Primary outcomes were time to tracheal intubation (TTI) and intubation success, whereas secondary outcomes were cumulative success ratio and the number of esophageal intubation (EI). TTI and success ratios were reported per attempt.Thirty paramedics completed the study. Median TTI with Truview EVO2 with CPR was 36 (interquartile range [IQR] 29.00–52.00), 22.5 (IQR 18.33–35.00), and 18 (IQR 11.00–23.00) seconds; MCL with CPR was 23 (IQR 18.92–36.90), 16.8 (IQR 14.00–22.31), and 14.5 (IQR 11.12–16.36) seconds; Truview EVO2 without CPR was 28.6 (IQR 24.02–38.34), 21.7 (IQR 17.00–25.00), and 13 (IQR 11.90–17.79) seconds; MCL without CPR was 17 (IQR 13.23–22.29), 13 (IQR 12.09–15.26), and 12.4 (IQR 10.08–19.84) seconds for first, second, and third attempts, respectively. The P values for differences in TTI between Truview EVO2 and MCL were P < 0.0001, P = 0.0540, and P = 0.7550 in CPR scenario and P = 0.0080, P = 0.1570, and P = 0.7652 in no-CPR scenario for first, second, and third attempts, respectively. The success ratios for each of the scenarios were as follows: in CPR scenario it was 0.73 versus 0.53 (P = 0.0558), 0.83 versus 0.76 (P = 0.2633), and 1 versus 0.8 (P = 0.0058); in no-CPR scenario it was 0.63 versus 0.73 (P = 0.2068), 0.86 versus 0.86, and 0.97 versus 1 (P = 0.1637) for Truview EVO2 vs MCL in first, second, and third attempts, respectively.The cumulative success ratio related to the time of ETI was better for MCL compared with Truview EVO2 laryngoscope in both scenarios (P = 0.0029 and P = 0.0004 in no-CPR and CPR scenarios). The number of EI with MCL was 30% versus 13.3% (P = 0.0113), and for Truview EVO2 it was 20.45% versus 15.56% in CPR and no-CPR scenarios, respectively.The application of Truview EVO2 during uninterrupted chest compressions increased TTI but increased the success ratio of ETI and decreased number of EIs.

Comparative Study of Truview Evo2 Laryngoscope With Macintosh Laryngoscope for Laryngoscopy and Intubation In Adults Receiving General Anaesthesia for Elective Surgeries

“…One study was congruent with ours regarding increased number of 9 attempts with truview but other studies found more number of 10,[20][21][22]26 attempts with macintosh and equal number of attempts in both 12,13,16,19,25 groups. Increase number of attempts required for intubation in Truview Evo2 laryngoscope was may be due to relative inexperience with the newer device.…”

Comparison of Four Laryngoscopes for Orotracheal Intubation by Nurses During Resuscitation With and Without Chest Compressions: A Randomized Crossover Manikin Trial

“…The average time of intubation [12]. In the study by Gaszyńska et al, the MAC intubation time was 16.6 s, while the first attempt efficiency equalled 73.3% [14]. However, in another study Gaszyńska obtained a first attempt effectiveness of 53.3% and a total effectiveness of 80% [31].…”

“…Gaszyńska et al, in a group of 30 paramedics, noted that the necessary time to perform intubation with the MAC In cases of intubation with EVO2, the nurses were able to achieve a first attempt effectiveness of 68.8% and an overall efficiency of 87.2% within 35.5 s (IQR, 27-36.5 s). In the study by Gaszyńska et al, the efficacy of the first intubation attempt was 63.3%, with a total efficiency of 90% and a median duration of 28.64 s (24.02-38.34 s) [14]. Singh showed an 88% effectiveness of EVO2 intubation performed in 28.6 s [18].…”

“…Regarding the EVO2, the endotracheal intubation time was 42.5 s (IQR, 39-47.5 s) which turned out to be statistically significantly longer than the MAC intubation time. In the studies by Gaszyńska, paramedics were able to perform intubation using MAC with uninterrupted CC within 36 s (IQR, 29-52 s), with an effectiveness rate of the first intubation attempt of 73.3% and a total efficiency of 100% [14]; Szarpak et al, evaluating the intubation efficiency in newborns in CPR conditions, obtained an average intubation time of 25.3 s (23-30.5 s) and an overall effectiveness of 94.9% [22].…”

Porównanie skuteczności Pentax AWS S-100 i laryngoskopu z łopatką Macintosha podczas intubacji dotchawiczej dziecka w warunkach symulowanej resuscytacji – badanie randomizowane

“…Do badania zakwalifikowano 58 studentów ostatniego roku ratownictwa medycznego. Badania innych autorów wskazują, że w celu porównania skuteczności różnych metod intubacji wystarczająca jest 30-osobowa grupa badawcza [7,8]. Badanie zostało przeprowadzone w marcu 2015 r.…”