Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: A manikin study

doi:10.1016/j.resuscitation.2010.05.020

Resuscitation

Volume 81, Issue 9, September 2010, Pages 1172-1174

https://doi.org/10.1016/j.resuscitation.2010.05.020 Get rights and content

Abstract

Background

If tracheal intubation can be performed during uninterrupted chest compressions, this will sustain circulation during the procedure of intubation and may lead to successful resuscitation. We compared three types of laryngoscope on a manikin as to whether they enabled tracheal intubation while the manikin's chest was rhythmically compressed.

Methods

A total of 35 persons who had little or no experience in intubation served as examinees. The laryngoscopes employed were a conventional Macintosh laryngoscope (MAC), a new video laryngoscope, Pentax-AWS (AWS) and an optic laryngoscope Airtraq (ATQ). During chest compression on the manikin by an assistant, the examinee attempted to perform intubation. The success rate and the time for successful intubation were measured.

Results

During rhythmic chest compressions, nine examinees failed in tracheal intubation with the MAC, seven failed with the ATQ, and no one failed with the AWS. The success rates with the AWS were significantly higher than those with the MAC (P < 0.01) or ATQ (P < 0.05). The time needed for intubation was significantly shorter with the Pentax-AWS than with the others.

Conclusions

These results suggest that the use of the Pentax-AWS enables tracheal intubation while the patient's chest is rhythmically compressed, and would more often lead to successful intubation, which in turn may lead to more successful resuscitation.

Section snippets

Methods

A total of 35 persons who had little or no experience in tracheal intubation participated in this study as examinees. They included 11 junior doctors, 18 nurses, 4 medical students and 2 paramedics. The examinees were randomly divided into three groups (12 or 11 examinees a group). Each group underwent the test on a different day. Three kinds of laryngoscopes: a conventional Macintosh laryngoscope (MAC), a new video laryngoscope Pentax-AWS (AWS) and an optic laryngoscope Airtraq (ATQ) were used

Results

Table 1 shows the results of the success rates of tracheal intubation according to the laryngoscopes. On the simulator at rest, all of 35 examinees succeeded in tracheal intubation with the AWS or ATQ, and two of 35 examinees failed with the MAC. However, there was no statistically significant difference in the success rates among the laryngoscopes. On the simulator on which the chest was rhythmically compressed, nine examinees failed in tracheal intubation with the MAC, seven failed with the

Discussion

The results of this study showed that using the video laryngoscope (AWS), all inexperienced examinees succeeded in tracheal intubation on the simulator whose chest was rhythmically compressed. In contrast, using the conventional laryngoscope (MAC), some of the inexperienced examinees, who succeeded in intubation on the simulator at rest, failed in intubation on the simulator with chest compressions. The time needed for successful intubation was much shorter with the AWS than with the others.

Conflict of interest statement

None to declare.

Acknowledgement

We thank Dr. Akimi Ogawa, director of Ina Central Hospital, for his critical reading of the manuscript.

References (8)

M.A. Malik et al.
Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation
Br J Anaesth
(2009)
T. Sadamori et al.
Video laryngoscopy for emergency tracheal intubation during chest compression
Resuscitation
(2008)
A. Timmermann et al.
Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians
Resuscitation
(2006)
H.E. Wang et al.
Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation
Ann Emerg Med
(2009)

There are more references available in the full text version of this article.

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A randomized crossover trial was conducted to evaluate 4 airway devices: laryngeal mask airway (LMA), i-gel (iGEL), PENTAX Airway Scope (AWS), and Macintosh laryngoscope (MCL). Thirty-eight unskilled rescuers performed intubation on a manikin during chest compressions in normal and difficult airway scenarios. The time to ventilation, intubation success rate, and difficulty of intubation were measured.
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^☆: A Spanish translated version of the abstract of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2010.05.020.

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Simulation and educationComparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: A manikin study☆

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conflict of interest statement

Acknowledgement

Br J Anaesth

Resuscitation

Resuscitation

Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation

Ann Emerg Med

Simulation and education
Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: A manikin study☆