The efficacy of endotracheal intubation utilizing INTUBRITE laryngoscope during cardiopulmonary resuscitation
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American Journal of Emergency Medicine
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The efficacy of endotracheal intubation utilizing INTUBRITE laryngoscope during cardiopulmonary resuscitation
Sir:
We have read with great interest an article “Comparison of the Intubrite and Macintosh laryngoscope in difficult airway scenario” in which the authors compared the efficacy of Video laryngoscopy and di- rect laryngoscopy [1]. They showed that the use of video laryngoscopy increases the effectiveness of endotracheal intubation in conditions of Difficult airways. In the reality of emergency medical service endotra- cheal intubation, due to widespread availability, is a gold standard for the protection of airways. However, as indicated by numerous studies, endotracheal intubation should be performed by the most experienced person in the rescue team [2,3]. Unfortunately besides the obvious ben- efits of maintaining airway patency with this method e.g. possibility of positive pressure ventilation, there are also numerous potential compli- cations when performing this procedure. When poorly performed it can lead to tissue damage, cause bleeding, as well as dislocation of artenoid cartilage, breakage or epiglottis, rupture of vocal folds or trachea and formation of pneumomediastinum. Due to the high learning curve of
direct laryngoscopy [4], the use of video laryngoscopy, as indicated by numerous studies, may increase the effectiveness of this procedure, es- pecially when performed by people who have limited experience in di- rect laryngoscopy. Many studies confirm that people without previous experience in video laryngoscopy after completing a short training are able to perform intubation with high efficiency [5-8].
The aim of this study was to attempt to confirm this assumption. In
order to do it a comparison of the effectiveness of endotracheal intuba- tion using different intubation techniques performed by the medical students in their final year was made.
The study included 35 medicine students in their final year with no
prior experience with video laryngoscopy. Prior to the study partici- pants received both practical and theoretical training in endotracheal laryngoscopy using Macintosh blade laryngoscope (MAC; Heine USA Ltd. Dover, NH) and an Intubrite videolaryngoscope (Intubrite; IntuBrite, LLC., Vista, CA, USA; Fig. 1). After theoretical part and demon- strating the correct way of performing intubation procedure each of the participants had the opportunity to perform 10 endotracheal intubation attempts using both MAC and Intubrite in normal airway conditions. The actual comparison was carried out on the Resusci Anne Advanced SkillTrainer SimPad (Laerdal, Stavanger, Norway). In order to simulate the difficulties resulting from compressing the chest, chest compres- sions system in the Continuous chest compressions mode was used. We analyzed parameters such as the effectiveness of the first intubation
Fig. 1. Endotracheal intubation with intubrite videolaryngoscope.
0735-6757/(C) 2018
test, the procedure execution time, percentage of glottis visualization and the ease of performing the procedure were based on a 10-degree scale (1- procedure easy to perform, 10-procedure difficult to perform). The effectiveness of the first endotracheal intubation attempt utiliz- ing the MAC laryngoscope was 40% vs. 51.4 when using Intubrite, the difference was statistically significant (p = 0.003). The average time required for the procedure of endotracheal intubation was statisti- cally significantly different and for MAC it was - 41.5 +- 10.5 s vs. Intubrite - 35.5 +- 12 s (p = 0.027). The glottis visualization degree for the Intubrite videolaryngoscope was 86 +- 8 vs. 65 +- 14% for the MAC (p b 0.001). The easiness of performing intubation assessed by study participants was 4 +- 1.5 points vs. 7.5 +- 2 points for Intubrite and
MAC respectively.
To sum up final year medical students performed an endotracheal intubation during a cardiopulmonary resuscitation in simulated envi- ronment with higher efficacy and shorter time when using Intubrite compared to Macintosh. The study showed that the learning process of endotracheal intubation is shorter when using video laryngoscopy then when learning direct laryngoscopy.
Wladyslaw B. Gawel, MS
Student’s Scientific Association of Children’s Diabetology of Medical
University of Silesia, Poland
Halla Kaminska, PhD, MD
Department of Children’s Diabetology, Medical University of Silesia,
Katowice, Poland
Wojciech Wieczorek, MSc, EMT-P Department of Anaesthesiology, Intensive Care and EmergencyMedicine in Zabrze, Medical University of Silesia, Katowice, Poland Corresponding author at: Department of Anaesthesiology and Intensive Therapy, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 41-800 Zabrze, 3 Maja 13/15 Str., Poland.
E-mail address: [email protected]
24 January 2018
https://doi.org/10.1016/j.ajem.2018.01.081
Smereka J, Ladny JR, Szarpak L. Comparison of the Intubrite and Macintosh laryngo- scopes in a difficult airway scenario. Am J Emerg Med Jun 2017;35(6):925. https:// doi.org/10.1016/j.ajem.2017.03.067.
Videolaryngoscopy for physician-based, prehospital emergency intubation: a pro- spective, randomized, multicenter comparison of different blade types using A.P. Ad- vance, C-MAC System, and KingVision. Anesth Analg Dec 11 2017. https://doi.org/10. 1213/ANE.0000000000002735.
Aghamohammadi H, Massoudi N, Fathi M, Jaffari A, Gharaei B, Moshki A. Intubation learning curve: comparison between video and direct laryngoscopy by inexperienced students. J Med Life 2015;8(Spec Iss 4):150-3.
yngoscopy during simulated cardiopulmonary resuscitation. Am J Emerg Med Mar 2017;35(3):518-9. https://doi.org/10.1016/j.ajem.2016.12.026.
Bielski K, Smereka J, Ladny JR, Szarpak L. A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: a randomized cross- over manikin study. Am J Emerg Med May 2017;35(5):787-9. https://doi.org/10. 1016/j.ajem.2016.11.048.
Which method of chest compression should be used when resuscitating a newborn?
Sir,
About 10% of newborns need assistance to establish effective venti- lation [1] which remains the most critical step of neonatal resuscitation. Fortunately, the need for chest compressions in the delivery room is rare. Approximately 0.1% of term newborns and 15% of preterm new- borns require chest compression at birth due to birth asphyxia [2]. high quality chest compressions improve cerebral and myocardial per- fusion. While the medical staff performs cardiopulmonary resuscitation in adult patients almost routinely, there is a general fear of cardiopul- monary resuscitation in children and newborns. American Heart Associ- ation guidelines recommend that in the case of a single person resuscitation of the newborn it should be carried out using the tech- nique of two fingers and when performed by two people the method of two thumbs should be the preferred method [3]. Numerous authors proposed various modifications of the two-finger method. Recently the article “A randomized comparison of three chest compression tech- niques and the associated hemodynamic effect during infant CPR: A ran- domized manikin study” was published in the American Journal of Emergency Medicine [4], in which the authors describe an innovative method of chest compressions in infants and then compare it with cur- rently recommended two other methods. This study was also extended by a group of newborns immediately after birth, who were simulated by the most advanced simulator in the world [5]. The results obtained by Smereka indicate that the chest compression method proposed by him may become a staple method in the guidelines for cardiopulmonary resuscitation of infants and newborns. Obviously, studies conducted by Smereka [4-7] are simulation studies which require transfer to real pa- tients, however the results are promising. Therefore, further studies are necessary to develop new techniques of optimizing the quality of the chest compression in each age group.
Source of support
No sources of financial and material support to be declared.
Ali Rezaee, MS
Emergency Medicine Student Scientific Circle, Medical University of
Warsaw, Warsaw, Poland
Marcin Madziala, DPH, EMT-P
Department of Emergency Medicine, Medical University of Warsaw,
Warsaw, Poland International Institute of Rescue Research and Education, Warsaw, Poland Corresponding author at: Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya str., 02-005Warsaw, Poland.
E-mail address: [email protected]
https://doi.org/10.1016/j.ajem.2018.01.086
References
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- Shah PS. Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a sys-
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Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for