A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest.

BACKGROUND: Intubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA. METHODS: We performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis. RESULTS: Over a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance. CONCLUSIONS: We found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics. TRIAL REGISTRATION: Trial was registered in Clinical Trials: NCT05607836 (10/28/2022).

A randomized controlled study on the visual grading of the glottis and the hemodynamics response to laryngoscopy when using I-View and MacGrath Mac videolaryngoscopes in super obese patients.

BACKGROUND: Videolaryngoscopes improve visualization of glottic in morbidly obese patients. Super-obesity is one of the risk factors influencing probability of difficult mask ventilation and difficult intubation. Super-obese (BMI > 50 kg/m2) patients should be intubated either with fiberscope awake intubation or with video laryngoscopes. METHODS: In prospective observational study we decided to compare glottis view during intubation using I-view and McGrath Mac videolaryngoscopes in super obese patients. Patients were randomly allocated into group M (McGrath Mac) or group I (I-View). Obtained view was analyzed regarding POGO (Percentage Of Glottis Opening) scale and the necessity to use of additional aid like intubation stylet was recorded. Hemodynamic response to videolaryngoscopy was assessed. RESULTS: As results POGO score was better in group M when compared to group I: 81.66 ± 22.8% vs 96.66 ± 7.24% (p = 0.0132) in I and V groups respectively. The use of intubation stylet was similar in both groups. The hemodynamic response to videolaryngoscopy was similar between groups. CONCLUSION: The POGO score was better for McGrath Mac than for I-view videolaryngoscope, however, both devices allowed for safe and effective intubation in super-obese patients. The hemodynamic response to videolaryngoscopy was similar between devices.

chronic kidney disease.

In a traditional epiglottis biopsy surgery, the operator performs the direct laryngoscopy to visualise an operating field. However, in patients with tumour-altered epiglottis, this procedure can be unsuccessful, because of difficult laryngeal exposure (DLE). This term refers to an insufficient visualisation of larynx, according to anatomical and pathological lesions. A CASE REPORT: The aim of paper was to present a video laryngoscopy performed for surgical purpose in patient with tumour-altered epiglottis. Woman 52 year old was admitted to hospital for planned surgical epiglottis biopsy under general anesthesia. We utilised McGrath video laryngoscope to provide a successful larynx visualisation during an epiglottic tumour biopsy procedure, when a rigid diagnostic laryngoscope failed. McGrath appeared to provide an excellent view of the larynx, which enable the operator to perform the biopsy of the tumour. The operation proceeded without any complications. CONCLUSIONS: In case of shared airway procedure, such as epiglottis biopsy examination, video laryngoscopy appeared to be an effective method to expose the entrance to larynx and enable the surgical manipulation at the same time.

[Comparison of intubation using duoscope double blade laryngoscope and standard Macintosh blade laryngoscope in manikin model]. / Porównanie intubacji za pomoca laryngoskopu z dwoma lyzkami ­ duoscope i laryngoskopu z lopatka Macintosh na modelu manekinowym.

Laryngoscope Duoscope (LD) is a disposable, plastic laryngoscope consisting of two different spoons connected by proximal parts, so that one alternately serves as a handle. AIM: The aim of study was to compare classical laryngoscope with the one-time Duoscope type. MATERIALS AND METHODS: The study was carried out on 30 patients of the third year of Medical Emergency, previously trained in instrumental airway clearance. It consisted of intubation of the phantom using a standard metal laryngoscope (MR) and a disposable plastic laryngoscope with a double spoon - Duoscope Laryngoscope (LD). After the intubation, each student completed an anonymous questionnaire regarding the time and effectiveness of intubation and the visibility of vocal folds and the general assessment of both laryngoscopes. RESULTS: The minimum time needed to perform intubation with MR is 16.02 s, and the maximum is 44.17 s, for LD analogically - 17.92 sec. 52.72 s. Mean MR intubation time was shorter than LD (26.43±6.22 s vs. 32.24±8.51 s, statistical significance level p <0.001). The average difference between the time of MR and LD intubation was 7.12 s. The second analyzed factor was the effectiveness of intubation; significantly higher with MR in relation to LD (90% vs. 43.3% efficiency, statistical significance level p<0.0001). The next analyzed factor was the visibility of vocal folds at laryngoscopy. It was after averaging for MR 84.3%, for LD 23%. The average LD score in the 10-point scale of the subjective assessment of the usability of the laryngoscope for intubation was 3.13 points (standard deviation 1.92, median 3 points). CONCLUSIONS: The results of the study strongly support the predominance of the classical laryngoscope over the one-time Duoscope type.

The pressure exerted on the tongue during intubation with simultaneous cervical spine immobilisation: a comparison between four videolaryngoscopes and the Macintosh laryngoscope-a manikin study.

Excessive pressures exerted on the tongue during intubation may be associated with serious complications and may make intubation more difficult. The aim of this study was to evaluate five different intubating devices in the hands of experienced anaesthetists during simulated conditions of reduced cervical spine mobility. Forty senior anaesthetists participated in the study (female = 18, male = 22). The mean pressure exerted on the tongue during intubation was recorded with a standard manometer. The overall intubation success rate as well as the difference in exerted pressures between female and male anaesthetists were also assessed. The five studied devices were used by each participant and they were randomly chosen. Each anaesthetists participating in the study had over 15 years of clinical anaesthetic practice. The mean pressure exerted on the tongue during intubation was significantly lower when the videolaryngoscopes (VLs) were used (p < 0.0001 for each of the studied VL). There were failed intubation attempts with all of the studied devices, the highest failure rate was in the Airtraq® group, 10 in 40 (25%). Female anaesthetists exerted lower pressures during intubation with all studied devices (except the Airtraq®). However, the difference was only significant for the Macintosh laryngoscope (p = 0.0083). The blades of VLs exerted lower pressures on the tongue during intubation than the Macintosh laryngoscope blade. Their use may be associated with less complications. Furthermore, male anaesthetists exerted higher pressures on the soft tissues although this was neither statistically nor clinically significant. There was higher failed intubation rate in the male anaesthetist group.

Comparison of ventilation effectiveness of the bag valve mask and the LMA Air-Q SP in nurses during simulated CPR.

In a case of sudden cardiac arrest (SCA) in a health facility there is a procedure to summon a resuscitation team. Nurses are obliged to begin cardiopulmonary resuscitation with chest compressions and implement ventilation using the bag valve mask of 30:2 compressionventilation ratio. Nurses are not allowed to implement methods of advanced airway management. However, the laryngeal mask airway (LMA) was designed for people inexperienced in intubation who would be able to provide advanced airway management quickly and effectively after a short training. It is advisable to check how nurses, who in case of SCA are often the first responders, deal with advanced airway management. AIM: The aim of the study was to evaluate the quality of ventilation using the bag valve mask and the LMA Air-Q SP by professionally active nurses. MATERIALS AND METHODS: The study was conducted on a 38-person group of professionally active nurses working or affiliated with the District Health Care Facility in Piotrków Trybunalski. After a short pre-training lecture the nurses were assigned to ventilate the manikin with the bag valve mask (BVM) using 30:2 compressionventilation ratio and then asynchronously with the use of the LMA Air-Q SP. RESULTS: The average time elapsed from the beginning of CPR to the onset of ventilation was 18 ± 5,4 s. as for the BVM and 16,15 ± 4,4 s regarding the LMA. Minute ventilation achieved with the BVM was 3,47 ± 1,43 l / min, and in case of the LMA it amounted 5,54 ± 1,73 l / min. There was no case of gastric insufflation in case of the LMA, while as for the BVM it occurred in five cases. There are very few studies focused on the LMA Air-Q SP, but some research (Jagannathan, Alexandera or Gruber) devoted to the use of the LMA in nurses, demonstrate that ventilation with the use of the LMA is effective and ensure more appropriate ventilation parameters than with the use of the BVM. CONCLUSIONS: The nurses achieved better ventilation results when using the LMA. Attempts to insert the LMA were shorter than in case of the BVM.

Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks: An International, Multicenter, Prospective Cohort Study.

BACKGROUND: Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. METHODS: The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. RESULTS: The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. CONCLUSIONS: The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

The European Board of Anaesthesiology recommendations for safe medication practice: First update.

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011. They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists. The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

[Comparison of Cmac vs Vivasight devices in terms of time and effectiveness of intubation among medical students]. / Porównanie urzadzen Cmac vs Vivasight pod katem czasu i skutecznosci intubacji wsród studentów medycyny.

While analysing the use of the new videolaryngoscopes in the hands of the well experienced anaesthesiologists it is difficult to get answers to all intriguing questions and gain insights that might arise only from the untrained users. We can form a thesis that if a manikin, with the use of a particular device, is intubated quickly and effectively by the novices, it is probable that the more experienced operators will be even more satisfied with its use. AIM: The aim of our study was to evaluate the effectiveness of the use of these devices in the hands of the users untrained in intubation. We also wanted to find out what are the subjective perceptions of using the devices by unsuccessful users. We investigated intubation times, effectiveness as well as parameters such as tooth damage. The aim of the secondary and obvious benefit to students was familiarity Them with new advanced methods of clearing the upper respiratory tract with which they will probably meet in the future. MATERIALS AND METHODS: The study included 104 medical students. Every participant took three attempts to intubate the manikin using each device. The technical parameters of the devices have been studied by the experts from the Lodz University of Technology. RESULTS: The average time of intubation in the case of the Cmac was 28,3±10,1, while as regards the Vivasight the average time of intubation was 30,9±9,0. In order to check the statistical significance, the Mann - Whitney U test was used (p <0,005). A larger proportion of successful attempts that amounted to 60% were observed while using the CMAC. CONCLUSIONS: According to the subjective opinion of the students, the Cmac is easier to operate than the Vivasight. This study proved that videolaryngocopes can be a great tool for training new methods of intubation even during studies.

A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study.

INTRODUCTION: Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin. METHODS: This was an open, prospective, randomized, crossover, manikin trial involving 95 paramedics who performed intubations in a PediaSIM pediatric high-fidelity manikin with Macintosh and McGrath laryngoscopes, with and without concomitant mechanical CCs. Primary outcome was the TTI, and secondary outcome was success of the attempt. Participants rated their best glottic view, the severity of the potential dental trauma, and subjective opinion about the difficulty of the procedure. RESULTS: The median TTI with the Macintosh in the scenario with uninterrupted CC was 33 (interquartile range [IQR], 24-36) seconds, which is significantly longer than TTI in the scenario with interrupted CC (23 [IQR, 20-29] seconds, P < .001). Time to intubation using the McGrath was similar in both scenarios: 20 (IQR, 17-23) seconds vs 19.5 (IQR, 17-22) seconds (P = .083). A statistically significant difference between McGrath and Macintosh was noticed in TTI both in scenario with (P < .001) and without CC (P = .017). CONCLUSIONS: McGrath video laryngoscope helps paramedics to intubate a pediatric manikin in a CPR scenario in less time and with fewer attempts than with the classical Macintosh, both in case of ongoing or stopped CC. McGrath use in actual patients could improve CPR quality by paramedics.

The comparison of the technical parameters in endotracheal intubation devices: the Cmac, the Vividtrac, the McGrath Mac and the Kingvision.

Currently, there are plenty of videolaryngoscopes that appear on the market. They have different specifications. Some of these features favor the fact that they are more suited for educational purposes of future operators and others can be characterized with an excellent clinical use. In this study we compared four types of videolaryngoscopes. The aim of the study was to compare the technical specifications of the above-mentioned devices for usefulness in clinical practice and correlate these parameters with the subjective evaluation of these videolaryngoscopes usage performed in practice by an experienced medical staff. All devices considered in this study participated in another multicenter clinical study on the basis of which we completed the subjective evaluation of the operators. In order to examine the technical parameters of the equipment we established the cooperation with the Department of Microelectronics at Technical University of Lodz. Mechanical and optical parameters and the endoscopic tube current were taken into consideration. The C-MAC has a camera with the widest viewing angle (the OX axis-63.1, the axis OY-47.8), which in combination with the largest diagonal size of the display enables the operator to see the details relevant to clinical practice. It has also the strongest lamp intensity of the devices mentioned in this comparison (7800 Lx). In comparison of the clinical use in almost all compared parameters the Cmac D-blade is a winner, although for clinical education purpose we consider the Vividtrac a better device.

Muscle activity during endotracheal intubation using 4 laryngoscopes (Macintosh laryngoscope, Intubrite, TruView Evo2 and King Vision) - A comparative study.

BACKGROUND: Successful endotracheal intubation requires mental activity and no less important physical activity from the anesthesiologist, so ergonomics of used devices is important. The aim of our study has been to compare 4 laryngoscopes regarding an operator's activity of selected muscles of the upper limb, an operator's satisfaction with used devices and an operator's fatigue during intubation attempts. MATERIAL AND METHODS: The study included 13 anesthesiologists of similar seniority. To measure muscle activity MyoPlus 2 with 2-channel surface ElectroMyoGraphy (sEMG) test device was used. Participant's satisfaction with studied devices was evaluated using Visual Analog Scale. An operator's fatigue during intubation efforts was evaluated by means of the modified Borg's scale. RESULTS: The highest activity of all the studied muscles was observed for the Intubrite laryngoscope, followed by the Mackintosh, TruView Evo2 and the lowest one - for the King Vision video laryngoscope. A significant statistical difference was observed for the King Vision and the rest of laryngoscopes (p < 0.05). No significant statistical differences were observed between the Macintosh, TruView Evo2 and Intubrite laryngoscopes (p > 0.05). The shortest time of intubation was achieved using the standard Macintosh blade laryngoscope. The highest satisfaction was noted for the King Vision video laryngoscope, and the lowest for - the TruView Evo2. The Intubrite was the most demanding in terms of workload, in the opinion of the participants', and the least demanding was the King Vision video laryngoscope. CONCLUSIONS: Muscle activity, namely the force used for intubation, is the smallest when the King Vision video laryngoscope is used with the highest satisfaction and lowest workload, and the highest muscle activity was proven for the Intubrite laryngoscope with the highest workload. Med Pr 2016;67(2):155-162.

Comparison of Coopdech®, CoPilot®, Intubrite®, and Macintosh laryngoscopes for tracheal intubation during pediatric cardiopulmonary resuscitation: a randomized, controlled crossover simulation trial.

UNLABELLED: The aim of the study was to compare the intubation times and success rates of various laryngoscopes during resuscitation in pediatric emergency intubation with uninterrupted chest compression on a standardized pediatric manikin model. This was a randomized crossover study with 107 paramedic participants. We compared times to successful intubation, intubation success rates, and glottic visibility using a Cormack-Lehane grade for Macintosh, Intubrite®, Coopdech®, and Copilot® laryngoscopes. One hundred seven paramedics (mean age 31.2 ± 7.5 years) routinely involved in the management of prehospital care participated in this study. Intubation success rates (overall effectiveness), which was the primary study endpoint, were highest for the Coopdech® and CoPilot® devices (100 %) and were lowest for Intubrite® (89.7 %, p < 0.001) and Macintosh (80.4 %, p < 0.001). The secondary study endpoint, time to first effective ventilation, was achieved fastest when using the Coopdech® laryngoscope (21.6 ± 6.2 s) and was significantly slower with all other devices (Intubrite® 25.4 ± 10.5 s, p = 0.006; CoPilot® 25.6 ± 7.4 s, p = 0.007; Macintosh 29.4 ± 8.2 s, p < 0.001). CONCLUSION: We conclude that in child simulations managed by paramedics, the Coopdech® and Copilot® video laryngoscopes performed better than the standard Macintosh or Intubrite® laryngoscopes for endotracheal intubation during child chest compression.

Comparison of supraglottic airway laryngopharyngeal tube, oropharyngeal and nasopharyngeal airway use by Polish soldiers on the manikin with difficult airway.

UNLABELLED: Airway obstruction represents 6% of avoidable deaths in a combat zone. Statistical analysis of deaths in the battlefield during combat missions in Iraq and Afghanistan shows that 1% of the soldiers are killed because of airway obstruction. The aim of the study was to objectively evaluate the use of S.A.L.T. (Supraglottic Airway Laryngopharyngeal Tube), oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) on the manikin with difficult airway to assess the risk of air introduction into the stomach during ventilation trauma patient and time of insertion of each device. MATERIAL AND METHODS: A prospective study was conducted with the participation of 34 soldiers of the Polish Armed Forces (PAF). They ventilated a manikin using testing devices, to assess the volume of air entering the lungs and the stomach we used specially constructed flowmeters. The mean and median values of all measurements were calculated and compared by means of the Student's t test. RESULTS: 102 device placements and 204 ventilations were performed and evaluated during the study. The median time required for placement of S.A.L.T. was 12.44 sec vs 13.32 sec for NPA vs 9,34 sec for OPA (p<0.05). Mean volumes of air entering the lungs and stomach during ventilation with S.A.L.T. were (ml) 194.23 and 166 respectively, for NPA 218.13 vs 200.93 and for OPA 197.47 vs 169.22. CONCLUSIONS: Total volume of air entering into the stomach using S.A.L.T. was the lowest among all three devices. The use of NPA did not show any clinically important advantage, the fastest insertion time for OPA may be of value in the battlefield.

Usage of soft bougie for intubation via supraglottic airway devices.

UNLABELLED: An effective and dexterously established airway management of patients in life-threatening conditions is one of the basic procedures. Endotracheal intubation is considered to be the best method, however when, difficulties occur, it is indispensable to use of alternative methods with expertise. AIM: The aim of the research is to compare the effectiveness of endotracheal intubation management while using 5 different supragrottic airway devices with and without a flexible tracheal tube introducer. MATERIALS AND METHODS: The study was performed with use of the following devices: : Intersurgical Solus LMA, Ambu Curve LMA, iGEL, Cobra PLA, Air-Q and with the Eschmann bougie tracheal tube introducer. 30 students of medical rescuing took part in it. The observed elements were effectiveness of the intubation management and time needed for its conduction. RESULTS: Efficient intubation without the bougie was executed in the following percent of cases: LMA - 30%, iGEL - 67%, AmbuCurve LMA - 20%, Air-Q - 23%, Cobra PLA - 30%. Usage of the tracheal tube introducer does not improve the effectiveness of the intubation management with Supragrottic airway devices, on the contrary - it diminishes it. The percent of successful trials was: Ambu LMA Curve - 3%, Cobra PLA - 10%, iGEL - 27%. Intubation was not performed using the LMA and Air-Q. The shortest time of intubation was measured while using LMA Curve (24,8 s / 31,2 s). CONCLUSIONS: Usage of soft track does not increase the effectiveness of intubation by any of the equipment or even the effectiveness decreases. IGEL device shows the highest effectiveness in both groups. The mean duration of intubation was achieved with the LMA Curve.