Abstract
Background Tracheal intubation still represents the “gold standard” in securing the airway of unconscious patients in the prehospital setting. Especially in cases of restricted access to the patient, video laryngoscopy became more and more relevant. Objectives The aim of the study was to evaluate the performance and intubation success of four different video laryngoscopes, one optical laryngoscope, and a Macintosh blade while intubating from two different positions in a mannequin trial with difficult access to the patient. Methods A mannequin with a cervical collar was placed on the driver's seat. Intubation was performed with six different laryngoscopes either through the driver's window or from the backseat. Success, C/L score, time to best view (TTBV), time to intubation (TTI), and number of attempts were measured. All participants were asked to rate their favored device. Results Forty-two physicians participated. 100% of all intubations performed from the backseat were successful. Intubation success through the driver's window was less successful. Only with the Airtraq® optical laryngoscope, 100% success was achieved. Best visualization (window C/L 2a; backseat C/L 2a) and shortest TTBV (window 4.7 s; backseat 4.1 s) were obtained when using the D-Blade video laryngoscope, but this was not associated with a higher success through the driver's window. Fastest TTI was achieved through the window (14.2 s) when using the C-MAC video laryngoscope and from the backseat (7.3 s) when using a Macintosh blade. Conclusions Video laryngoscopy revealed better results in visualization but was not associated with a higher success. Success depended on the approach and familiarity with the device. We believe that video laryngoscopy is suitable for securing airways in trapped accident victims. The decision for an optimal device is complicated and should be based upon experience and regular training with the device.
Highlights
Tracheal intubation still represents the most common way in securing the airway of unconscious patients in the prehospital setting and remains an important clinical skill for emergency physicians [1]
Fastest to intubation (TTI) was achieved through the window (14.2 s) when using the C-MAC video laryngoscope and from the backseat (7.3 s) when using a Macintosh blade
Video laryngoscopy has been implemented in many institutions as part of the airway management standard operating procedures, in addition to being in the international airway management guidelines [6, 7]; within the last decade, various video laryngoscopes by different manufacturers have flooded the market, making it difficult to choose the optimal device for different scenarios and circumstances
Summary
Tracheal intubation still represents the most common way in securing the airway of unconscious patients in the prehospital setting and remains an important clinical skill for emergency physicians [1]. The access to the patient is limited, and intubation conditions are even more difficult than normal ones [8] Another important aspect is the increased risk of aspiration based on nonfasting patients and, if cervical spine trauma is suspected, the need for cervical immobilization during the intubation process. It has been shown that there are a significantly higher incidence of difficult airway [9] and an increased mortality risk within this subset of patients [10], especially in major trauma patients associated with a coexisting cranial pathology (e.g., Glasgow coma scale score of 8 or less).
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