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Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim.
Eur J Anaesthesiol. 2011 Dec; 28(12):849-58.EJ

Abstract

CONTEXT

No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims.

OBJECTIVE

The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy.

DESIGN

Prospective, controlled, randomised crossover trial.

SETTING

An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door.

PARTICIPANTS

Twenty-five experienced anaesthetists.

INTERVENTION

Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting.

MAIN OUTCOME MEASURES

Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant.

RESULTS

Twenty-five anaesthetists (35.1 ± 7.3 years; 16 male, nine female) with an intubation experience of 374 ± 96 intubations per year and an experience of 9.1 ± 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P < 0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P = 0.031).

CONCLUSION

When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study.

Authors+Show Affiliations

From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21986981

Citation

Wetsch, Wolfgang A., et al. "Success Rates and Endotracheal Tube Insertion Times of Experienced Emergency Physicians Using Five Video Laryngoscopes: a Randomised Trial in a Simulated Trapped Car Accident Victim." European Journal of Anaesthesiology, vol. 28, no. 12, 2011, pp. 849-58.
Wetsch WA, Carlitscheck M, Spelten O, et al. Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim. Eur J Anaesthesiol. 2011;28(12):849-58.
Wetsch, W. A., Carlitscheck, M., Spelten, O., Teschendorf, P., Hellmich, M., Genzwürker, H. V., & Hinkelbein, J. (2011). Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim. European Journal of Anaesthesiology, 28(12), 849-58. https://doi.org/10.1097/EJA.0b013e32834c7c7f
Wetsch WA, et al. Success Rates and Endotracheal Tube Insertion Times of Experienced Emergency Physicians Using Five Video Laryngoscopes: a Randomised Trial in a Simulated Trapped Car Accident Victim. Eur J Anaesthesiol. 2011;28(12):849-58. PubMed PMID: 21986981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim. AU - Wetsch,Wolfgang A, AU - Carlitscheck,Martin, AU - Spelten,Oliver, AU - Teschendorf,Peter, AU - Hellmich,Martin, AU - Genzwürker,Harald V, AU - Hinkelbein,Jochen, PY - 2011/10/12/entrez PY - 2011/10/12/pubmed PY - 2012/8/11/medline SP - 849 EP - 58 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 28 IS - 12 N2 - CONTEXT: No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims. OBJECTIVE: The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy. DESIGN: Prospective, controlled, randomised crossover trial. SETTING: An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door. PARTICIPANTS: Twenty-five experienced anaesthetists. INTERVENTION: Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting. MAIN OUTCOME MEASURES: Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant. RESULTS: Twenty-five anaesthetists (35.1 ± 7.3 years; 16 male, nine female) with an intubation experience of 374 ± 96 intubations per year and an experience of 9.1 ± 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P < 0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P = 0.031). CONCLUSION: When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/21986981/Success_rates_and_endotracheal_tube_insertion_times_of_experienced_emergency_physicians_using_five_video_laryngoscopes:_a_randomised_trial_in_a_simulated_trapped_car_accident_victim_ L2 - http://dx.doi.org/10.1097/EJA.0b013e32834c7c7f DB - PRIME DP - Unbound Medicine ER -