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McGrath-MAC vs Macintosh laryngoscopes for child tracheal intubation during

cardiopulmonary resuscitation?,??, ?,??

To the Editor,

We read with interest the article of Szarpak et al [1] entitled “A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics” and pub- lished in the American Journal of Emergency Medicine. In this article, the authors aimed to evaluate the impact of cardiopulmonary resuscitation, with and without chest compressions, on the success rates and time to intubation with the Macintosh laryngoscope vs the McGrath video la- ryngoscope on a Pediatric manikin. They found that McGrath video la- ryngoscope helps paramedics to intubate a pediatric manikin in a cardiopulmonary resuscitation scenario in less time and with fewer at- tempts than with the classical Macintosh, both in case of ongoing or stopped chest compressions. We congratulate the authors for this valu- able study.

In this study, participants were allocated to a sequence of 4 airway management procedures with one device, and then used the next one after a 15-minute break. We wonder whether the authors had observed a learning curve and whether these participants had a better time to in- tubation after the first attempt. It would also be of interest that each paramedic assessed the device used with a questionnaire related to the ease of use, the speed of handling, or the visualization of the glottis and the vocal cords.

Pierre-Geraud Claret, MD, MSc* Xavier Bobbia, MD, MSc

Jean Emmanuel de La Coussaye, MD, PhD

Department of Anesthesia Resuscitation Pain Emergency Medicine

Nimes University Hospital, Nimes, France

*Corresponding author at: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nimes University Hospital 1 place du Professeur Robert Debre, 30029 Nimes, France

E-mail addresses: [email protected], [email protected], [email protected]

http://dx.doi.org/10.1016/j.ajem.2016.09.022

? Authorship and author’s contributions: The authors confirm that they have read and approved the paper. All authors have given final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

?? Competing interests: The authors declare that they have no competing interests.

? Grant support: None.

?? Meeting: Study never presented.

1. Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodriguez-Nunez A. A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation dur- ing resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med 2016;34:1338-41.

Videolaryngoscopy or direct laryngoscopy for child tracheal intubation during cardiopulmonary resuscitation

To the Editor,

Thank you for your interest in our study, “A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intuba- tion during resuscitation by paramedics” [1]. Before the study, all of the participants completed a survey regarding their method and knowl- edge of endotracheal intubation. All of the participants declared their ability to perform endotracheal intubation with direct laryngoscopy using the Macintosh or the Miller laryngoscope. From the participant analysis survey, it is evident that none of the study’s participants had prior experience in intubation not even in simulation scenarios with the McGrath-MAC laryngoscope. The study’s participants, furthermore, did not have experience in intubation of a pediatric patient in emergen- cy conditions and the average experience of performed adult intubation is 7 +- 3 intubations. There was no correlation between having more prior experience in endotracheal intubation and performing successful intubation of pediatric patient during interrupted chest compressions. The analysis also portrayed that in intubation performed during periods of no chest compression, the same time to visualize the glottis was com- parable in both laryngoscope devices. In the scenario of performing intu- bation during chest compression, however, the time to visualize the glottis was shorter with the use of the McGrath-MAC as compared with the Macintosh laryngoscope, measured with the Cormack-Lehane scale. In the analysis of the effectiveness of each intubation attempt made by the participant, we assume that there is a shortened learning curve for laryngoscopy performed with the McGrath-MAC. Similar to our study, the studies further portray the advantages of direct laryngoscopy.

Lukasz Szarpak, PhD, DPH, EMT-P Department of Emergency Medicine Medical University of Warsaw, Warsaw, Poland

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

Tel.: +48 500 186 225 (Mobile)

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.09.023

Reference

1. Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodriguez-Nunez A. A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation dur- ing resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med 2016;34:1338-41.

procalcitonin levels predict identification of bacterial strains in blood cultures of septic patients: effect measures of association

To the Editor,

We were interested to read the article by Arai and colleagues [1] that was published online in the American Journal of Emergency Medicine. The authors aimed to evaluate the impact of extracted components from