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Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial

2011; Elsevier BV; Volume: 83; Issue: 6 Linguagem: Inglês

10.1016/j.resuscitation.2011.11.024

1873-1570

Wolfgang A. Wetsch, Oliver Spelten, Martin Hellmich, Martin Carlitscheck, Stephan A. Padosch, H. Lier, Bernd W. Böttiger, Jochen Hinkelbein,

Trauma Management and Diagnosis

Background The aim of the present study was to evaluate whether different video laryngoscopes (VLs) facilitate endotracheal intubation (ETI) faster or more secure than conventional laryngoscopy in a manikin with immobilized cervical spine. Methods After local ethics board approval, a standard airway manikin with cervical spine immobilization by means of a standard stiff collar was placed on a trauma stretcher. We compared times until glottic view, ETI, cuff block and first ventilation were achieved, and verified the endotracheal tube position, when using Macintosh laryngoscope, Glidescope Ranger, Storz C-MAC, Ambu Pentax AWS, Airtraq, and McGrath Series5 VLs in randomized order. Wilcoxon signed-rank test and McNemar's test were used for statistical analysis; p < 0.05 was considered as significant. Results Twenty-three anaesthetists (mean age 32.1 ± 4.9 years, mean experience in anaesthesia of 6.9 ± 4.8 years) routinely involved in the management of multitrauma patients participated. The primary study end point, time to first effective ventilation, was achieved fastest when using Macintosh laryngoscope (21.0 ± 7.6 s) and was significantly slower with all other devices (Airtraq 33.2 ± 23.9 s, p = 0.002; Pentax AirwayScope 32.4 ± 14.9 s, p = 0.001; Storz C-MAC 34.1 ± 23.9 s, p < 0.001; McGrath Series5 101.7 ± 108.3 s, p < 0.001; Glidescope Ranger 46.3 ± 59.1 s, p = 0.001). Overall success rates were highest when using Macintosh, Airtraq and Storz C-MAC devices (100%), and were lower in Ambu Pentax AWS and Glidescope Ranger (87%, p = 0.5) and in McGrath Series5 device (72.2%, p = 0.063). Conclusion When used by experienced anaesthesiologists, video laryngoscopes did not facilitate endotracheal intubation in this model with an immobilized cervical spine in a faster or more secure way than conventional laryngoscopy. However, data was gathered in a standardized model and further studies in real trauma patients are desirable to verify our findings.