Impact of VieScope® on first-attempt success during simulated COVID-19 patients intubation: A randomized cross-over simulation trial.

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs). METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random. RESULTS: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32-40) seconds and 35.8 (IQR: 30-40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001). CONCLUSION: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

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

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. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the 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 unexperienced physicians. METHODS: This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed. RESULTS: All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02733536.

Use of a Novel Grammatical Inference Approach in Classification of Amyloidogenic Hexapeptides.

The present paper is a novel contribution to the field of bioinformatics by using grammatical inference in the analysis of data. We developed an algorithm for generating star-free regular expressions which turned out to be good recommendation tools, as they are characterized by a relatively high correlation coefficient between the observed and predicted binary classifications. The experiments have been performed for three datasets of amyloidogenic hexapeptides, and our results are compared with those obtained using the graph approaches, the current state-of-the-art methods in heuristic automata induction, and the support vector machine. The results showed the superior performance of the new grammatical inference algorithm on fixed-length amyloid datasets.