Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child cardiopulmonary resuscitation: a randomized crossover manikin trial - 02/05/15

Doi : 10.1016/j.ajem.2015.04.017

Lukasz Szarpak, PhD, MPH, EMT-P ^a,^{^⁎} , Katarzyna Karczewska, MD ^b, Togay Evrin, MD ^c, Andrzej Kurowski, PhD, MD ^d, Lukasz Czyzewski, PhD, RN ^d,^e
^a Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
^b Anesthesiology and Intensive Care Unit, Mazovian Regional Hospital, Radom, Poland
^c Department of Emergency Medicine, UFuK University Medical faculty Dr. Ridvan Ege Education and Research Hospital, Ankara, Turkey
^d Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
^e Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland

^⁎Corresponding author. Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 St, 02-005 Warsaw, Poland. Tel.: +48 500186225.

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Abstract

Backgroud

Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR.

Methods

One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation.

Results

The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively.

Conclusions

Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.

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Plan

Introduction

Materials and methods

Study population

Study design

Statistical evaluation

Multivariate regression analysis

Subjective assessment

Discussion

Conclusions

☆	Funding: This study was financed by the authors' own resources. There was no financial support by any of the companies mentioned in this manuscript.
☆☆	Authors’ contributions: conception and design: KK, TE, LS, AK, LC; analysis and interpretation: LS; drafting the manuscript for important intellectual content: KK, TE, LS, AK, LC.
★	Conflict of interest statement: The authors declare that they have no conflicts of interest. There are no sources of financial and material support to be declared. None of the companies were involved in any way in the study design, planning, execution, or analysis as well as in the writing of this manuscript.