Document Detail

Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim.
MedLine Citation:
PMID:  21986981     Owner:  NLM     Status:  MEDLINE    
CONTEXT: No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims.
OBJECTIVE: The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy.
DESIGN: Prospective, controlled, randomised crossover trial.
SETTING: An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door.
PARTICIPANTS: Twenty-five experienced anaesthetists.
INTERVENTION: Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting.
MAIN OUTCOME MEASURES: Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant.
RESULTS: Twenty-five anaesthetists (35.1 ± 7.3 years; 16 male, nine female) with an intubation experience of 374 ± 96 intubations per year and an experience of 9.1 ± 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P < 0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P = 0.031).
CONCLUSION: When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study.
Wolfgang A Wetsch; Martin Carlitscheck; Oliver Spelten; Peter Teschendorf; Martin Hellmich; Harald V Genzwürker; Jochen Hinkelbein
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  28     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-01     Completed Date:  2012-08-10     Revised Date:  2012-11-06    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  849-58     Citation Subset:  IM    
From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
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MeSH Terms
Accidents, Traffic*
Clinical Competence / standards*
Cross-Over Studies
Emergency Medical Services / methods,  standards*
Intubation, Intratracheal / instrumentation,  methods,  standards*
Middle Aged
Physicians / standards*
Prospective Studies
Time Factors
Video-Assisted Surgery / instrumentation,  methods,  standards*
Comment In:
Eur J Anaesthesiol. 2012 Oct;29(10):496-7; author reply 497-8   [PMID:  22634851 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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