A prospective study comparing standard laryngoscopy to the trachview videoscope system for orotracheal intubation by emergency medicine residents and medical students

Abstract

Study objectives: Flexible fiberoptic bronchoscopy is a skill that can be difficult for emergency physicians to use in the setting of an emergency intubation. The TrachView Videoscope (TV) consists of a narrow high-resolution fiberoptic cable whose tip is positioned at the distal end of the endotracheal tube. The image is displayed on a small portable bedside monitor. In this way, the TV does not alter the standard method of intubation but adds a second, possibly improved, view of the vocal cords. The TV has never been formally studied. We determine the ease of use and improvement in the percentage of glottic opening (POGO) score using the TV by individuals with various levels of intubation experience.Methods: The study was conducted in 2 phases on a mannequin model during an airway laboratory for emergency medicine residents and medical students in a university setting. Phase 1 consisted of a nonrandomized group sequential study design in which, after a 10-minute demonstration of the TV, emergency medicine residents assessed the POGO score using direct laryngoscopy (DL) and compared it with their observed POGO score using the TV. Part 2 consisted of a crossover study with first- and second-year medical students with no intubation experience. The students were randomized into 2 groups that differed by the method of intubation instruction given first: DL or TV. The students were given a 10-minute demonstration of each technique and had 2 attempts to return the demonstration. The POGO score noted by the student was recorded for each technique. The groups were then crossed and the process was repeated. Additional information collected from study subjects included ease of use of the TV and improvement in intubation using the TV.Results: In phase 1, the residents consisted of 4 postgraduate year (PGY)-1, 10 PGY-2, and 11 PGY-3 residents, and 3 participants whose level was not recorded, for a total of 28. Overall, the median POGO score for DL was 50%, and the median POGO score for TV was 100% (P<.001). The median difference in POGO scores (TV and DL) was as follows: 50% for PGY-1 residents, 50% for PGY-2 residents, and 25% for PGY-3 residents. As for ease of use, 85.7% (24) reported that the TV was “easy” to use, 10.7% (3) were undecided, and 3.6% (1) reported that the TV was “difficult” to use, whereas 82.1% (23) reported that the TV improved their intubation attempt, 14.3% (4) reported no difference, and 3.6% (1) reported that the TV made the intubation attempt more difficult. In phase 2, there were 37 participants. Overall, the median TV and DL POGO scores were 75% and 25%, respectively (P=.004). The median difference in POGO scores (TV and DL) for the 2 groups was as follows: 75% for group 1 and 50% for group 2. Of all the participants, 67.6% (25) ranked the TV as “easy” to use, 21.6% (8) were undecided, and 10.8% (4) ranked the TV as “difficult” to use, whereas 56.8% percent (21) reported that the TV improved their intubation attempts, 27% (10) reported no difference, and 10.8% (4) reported that the TV made the intubation attempts more difficult.Conclusion: The Trachview Videoscope is easy to use and improves the POGO score and subjective evaluation of performance for intubation by individuals with various experience levels.