Impact of VieScope® on First-attempt Success During Simulated COVID-19 Patients Intubation: A Randomized Cross-over Simulation Trial

Overview

Journal Ulus Travma Acil Cerrahi Derg

Specialties Emergency Medicine
General Surgery

Date 2023 Mar 30

PMID 36995204

Authors

Togay Evrin

Leyla Ozturk Sonmez

Lezsek Gadek

Michal Pruc

Alla Navolokina

Wojciech Wieczorek

Maciej Cyran

Jacek Smereka

Gul Deniz Ozkan

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs).

Methods: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random.

Results: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32-40) seconds and 35.8 (IQR: 30-40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001).

Conclusion: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

Citing Articles

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References

Ladny J, Sierzantowicz R, Kedziora J, Szarpak L . Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation. Am J Emerg Med. 2017; 35(3):518-519. DOI: 10.1016/j.ajem.2016.12.026. View

Szarpak L, Truszewski Z, Smereka J, Czyzewski L . Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study. Kardiol Pol. 2016; 74(12):1499-1504. DOI: 10.5603/KP.a2016.0107. View

Irons J, Pavey W, Bennetts J, Granger E, Tutungi E, Almeida A . COVID-19 safety: aerosol-generating procedures and cardiothoracic surgery and anaesthesia - Australian and New Zealand consensus statement. Med J Aust. 2020; 214(1):40-44. PMC: 7675478. DOI: 10.5694/mja2.50804. View

Szarpak L, Smereka J, Filipiak K, Ladny J, Jaguszewski M . Cloth masks versus medical masks for COVID-19 protection. Cardiol J. 2020; 27(2):218-219. PMC: 8016026. DOI: 10.5603/CJ.a2020.0054. View

Sanfilippo F, Tigano S, La Rosa V, Morgana A, Murabito P, Oliveri F . Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis. Braz J Anesthesiol. 2021; 72(2):291-301. PMC: 8556077. DOI: 10.1016/j.bjane.2021.08.017. View

Zhang M, Zheng H, Wang J . Strategy of using personal protective equipment during aerosol generating medical procedures with COVID-19. J Clin Anesth. 2020; 66:109911. PMC: 7247986. DOI: 10.1016/j.jclinane.2020.109911. View

Truszewski Z, Szarpak L, Smereka J, Kurowski A, Evrin T, Czyzewski L . Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial. Am J Emerg Med. 2016; 34(5):929-30. DOI: 10.1016/j.ajem.2016.02.054. View

Doukas D, Arquilla B, Halpern P, Silverberg M, Sinert R . The Impact of Personal Protection Equipment on Intubation Times. Prehosp Disaster Med. 2021; 36(4):375-379. DOI: 10.1017/S1049023X21000492. View

Ecker H, Kolvenbach S, Stranz S, Herff H, Wetsch W . Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario - a randomized, controlled simulation trial. BMC Emerg Med. 2021; 21(1):90. PMC: 8323300. DOI: 10.1186/s12873-021-00484-6. View

10.

Aziz M, Dillman D, Fu R, Brambrink A . Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012; 116(3):629-36. DOI: 10.1097/ALN.0b013e318246ea34. View

11.

Matek J, Kolek F, Klementova O, Michalek P, Vymazal T . Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel). 2021; 11(3). PMC: 8004982. DOI: 10.3390/diagnostics11030575. View

12.

Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodriguez-Nunez A . A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med. 2015; 34(8):1338-41. DOI: 10.1016/j.ajem.2015.11.060. View

13.

Pantazopoulos I, Kolonia K, Laou E, Mermiri M, Tsolaki V, Koutsovasilis A . Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study. J Emerg Med. 2021; 60(6):764-771. DOI: 10.1016/j.jemermed.2021.01.001. View

14.

Grieco D, Bongiovanni F, Chen L, Menga L, Cutuli S, Pintaudi G . Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies. Crit Care. 2020; 24(1):529. PMC: 7453378. DOI: 10.1186/s13054-020-03253-2. View

15.

Butchart A, Young P . The learning curve for videolaryngoscopy. Anaesthesia. 2010; 65(11):1145-6. DOI: 10.1111/j.1365-2044.2010.06522.x. View

16.

Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O . A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial. Medicine (Baltimore). 2016; 95(44):e5170. PMC: 5591099. DOI: 10.1097/MD.0000000000005170. View

17.

Smereka J, Szarpak L, Filipiak K, Jaguszewski M, Ladny J . Which intravascular access should we use in patients with suspected/confirmed COVID-19?. Resuscitation. 2020; 151:8-9. PMC: 7158769. DOI: 10.1016/j.resuscitation.2020.04.014. View

18.

Bogdanski L, Truszewski Z, Kurowski A, Czyzewski L, Zasko P, Adamczyk P . Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy Laryngoscopes. Am J Emerg Med. 2015; 33(12):1814-7. DOI: 10.1016/j.ajem.2015.09.005. View

19.

Szarpak L, Peacock F, Rafique Z, Ladny J, Nadolny K, Malysz M . Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022; 53:122-126. PMC: 8731221. DOI: 10.1016/j.ajem.2021.12.069. View

20.

Malysz M, Dabrowski M, Bottiger B, Smereka J, Kulak K, Szarpak A . Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial. Cardiol J. 2020; 27(5):497-506. PMC: 8078983. DOI: 10.5603/CJ.a2020.0068. View