Correspondence / American Journal of Emergency Medicine 34 (2016) 2029–2049

A comparison of GlideScope and Macintosh laryngoscopes for endotracheal intubation

performed by nurses?

To the Editor,

2041

Sebastian Aleksandrowicz, MSc, EMT-P

Polish Society of Disaster Medicine, Poland

Lukasz Szarpak, PhD, DPH, EMT-P

Department of Emergency Medicine

Emergency physicians, paramedics and nurses working in Emergency Medical Services in Poland are primarily responsible for rapid advanced airway management in many emergency situations, such as trauma or cardiopulmonary resuscitation [1,2]. Because endotracheal intubation is still considered the optimal method for airway management, medical staff should be able to intubate emergency patients. It is worth noting that in pre-hospital situations the patient should be treated as if they have a potentially full stomach and therefore an increased risk of aspira- tion of gastric contents into the respiratory tract [3]. Therefore, endotra- cheal intubation is the optimal method of securing airways.

The aim of the study was to evaluate GlideScope (GLS; Verathon Medical BV, Boerhaaveweg, Ijsselstein, The Netherlands) and Macinosh laryngoscopes (MAC; HEINE Optotechnik, Munich, Germany) for intu- bation on normal airways performed by nurses.

This study was approved by the institutional review board of the Inter- national Institute of Rescue Research and Education (Approval no. 22.06.2016.07), and written informed consent was obtained from each participant. After obtaining voluntary written informed consent, 35 nurses, aged 23 to 38 years with a minimum 1-year experience in the field of an- esthesiology and critical care or emergency medicine participated. The study was conducted in June 2016. Before the study, all participants re- ceived 30-minute training which included a demonstration of a proper en- dotracheal intubation procedure using GLS and MAC laryngoscopes. After the demonstration, participants had a 20-minute training session to ensure they were familiar with proper use of the laryngoscopes. Participants were split into two groups using ResearchRandomizer software (www. randomizer.org). The first group started intubation with GLS while the sec- ond used MAC. Participants had a maximum of three intubation attempts for each device. A semi rigid stylet was inserted in the tracheal tube. After completing the procedure, participants had a 20-minute rest and then per- formed intubation using the other device. The primary endpoint was the time to tracheal intubation. Secondary endpoints were the success of the first intubation attempt and overall intubation success rate. Moreover, we measured dental trauma, which was assessed using a previously described grading scale of pressure on the teeth (0 = none, 1 = mild, 2 = moderate and 3 = severe) [4]. Participants also rated the view of the larynx on the Cormack and Lehane classification system on a scale of I to IV [5]. At the end of the trial, participants rated the difficulty of using each device on a Vi- sual Analogue Scale from ‘0’ (extremely easy) to ’10’ (extremely difficult). Statistical analysis was performed with the Statistica statistical package ver- sion 12.0 for Windows (StatSoft, Tulsa, OK). P b .05 was considered statisti- cally significant.

The median time for endotracheal intubation was significantly longer when GLS was used compared to MAC (45.8 [interquartile range 41.5- 55.5] vs 37.5 [interquartile range 30-42.5], respectively; P = .009). Com- paring GLS and MAC, there was no significant difference in success of the first intubation attempt (68.5% vs 74.3%, respectively; P = .054), or overall intubation success rate (94.3% vs 100%; P = .87). The dental trauma index was significantly less when GLS was used compared to the MAC (P =

.032). The Cormack-Lehane classification was lower in the MAC group than the GLS group, but not statistically significant (P = .063). The Visual analogue scale score for the GLS group was significantly lower than the MAC group (3.2 vs 4.4 points, respectively; P = .012).

In conclusion, our findings demonstrate that although intubation takes longer with the GLS, its reduced intubation difficulty and improved glottic view make it more suitable than the MAC when intubation is per- formed by nurses. Moreover, lower forces are applied when the GLS is used to achieve tracheal intubation, which may reduce the dental injuries.

? Source of support: No sources of financial and material support to be declared.

Medical University of Warsaw, Warsaw, Poland

Corresponding author. Department of Emergency Medicine Medical University of Warsaw, Lindleya 4 Str., 02-005 Warsaw, Poland

Tel.: +48 500186225

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.07.047

References

1. Akin Paker S, Dagar S, Gunay E, Temizyurek Cebeci Z, Aksay E. Assessment of prehospital medical care for the patients transported to emergency department by ambulance. Turk J Emerg Med 2015;15(3):122-5. http://dx.doi.org/10.1016/j.tjem.2015.11.005.
2. Szarpak L, Karczewska K, Evrin T, Kurowski A, Czyzewski L. Comparison of intubation through the McGRATH MAC, GlideScope, AirTraq, and miller laryngoscope by para- medics during child CPR: a randomized crossover manikin trial. Am J Emerg Med 2015;33(7):946-50. http://dx.doi.org/10.1016/j.ajem.2015.04.017.
3. Truszewski Z, Szarpak L, Smereka J, Kurowski A, Evrin T, Czyzewski L. Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial. Am J Emerg Med 2016;34(5): 929-30. http://dx.doi.org/10.1016/j.ajem.2016.02.054.
4. Rodriguez-Nunez A, Oulego-Erroz I, Perez-Gay L, Cortinas-Diaz J. Comparison of the GlideScope Videolaryngoscope to the standard Macintosh for intubation by pediatric residents in simulated child airway scenarios. Pediatr Emerg Care 2010;26(10): 726-9. http://dx.doi.org/10.1097/PEC.0b013e3181f39b87.
5. Kurowski A, Szarpak L, Truszewski Z, Czyzewski L. Can the ETView VivaSight SL rival

   conventional intubation using the Macintosh laryngoscope during adult resuscitation by novice physicians?: a randomized crossover manikin study. Medicine (Baltimore) 2015;94(21), e850. http://dx.doi.org/10.1097/MD.0000000000000850.

   Public-access automated external defibrillators and defibrillation for out-of-hospital

   

   cardiac arrest?,??,?,??,???,???

   To the Editor,

   Out-of-hospital cardiac arrest (OHCA) is a Public health concern partic- ularly in aging societies [1]. Despite its poor prognosis at large, early inter- ventions, including chest compression and defibrillation using an Automated external defibrillator by bystanders, increase patient sur- vival probabilities. Defibrillation is an effective intervention for those with shockable arrhythmias [2]. In Japan, defibrillation by laypersons using public-access AEDs has been permitted since 2004. Reportedly, increasing the number of public-access AEDs has contributed to improving the prog- nosis of the patients [3]. For efficient use, public-access AEDs should be de- ployed in densely crowded places, such as public transport nodes. We examined the association between the deployment of AEDs in public trans- port nodes and the use of public-access defibrillators for OHCA patients.

   ? Contribution: SN and TS conceived the study design and obtained the data. SN ana- lyzed the data with the support of AT. All authors equally contributed to the interpretation of the results. SN drafted the manuscript and all authors equally contributed to revising

   and finalizing the manuscript.

   ?? Presentation: This study was presented at the 2nd International Conference on

   Transport and Health held in San Jose, California, USA, 13-15 June 2016.

   ? Funding support: this study was supported by JSPS KAKENHI (Grant No. 26249073).

   The funding body did not play any roles in the study.

   ?? Data access: the first author (SN) had full access to all the data in the study and takes

   responsibility for the integrity of the data and the accuracy of the data analysis. The first author (SN) conducted the data analyses and is responsible for the analyses.

   ??? Conflict of interest: none declared.

   ??? Ethical consideration: this study was approved by the ethics committee of Teikyo

   University School of Medicine.