Abstract
The aim of the present study was to evaluate whether the TruView video laryngoscope (TruView) facilitates pediatric endotracheal intubation (ETI) more quickly and safely than conventional Macintosh laryngoscope (MAC) in three manikin-based airway scenarios. This was a randomized crossover manikin study including 120 novice paramedics. The participants performed tracheal intubations using both TruView and MAC on a pediatric manikin in a control scenario (A), chest compression scenario (B), and chest compression cervical stabilization scenario (C). The sequence of scenarios was randomized. The primary outcome was time to intubation. Secondary outcomes were overall success rates, incidence of dental trauma, and ease of intubation. All intubation attempts were assessed by a trained assistant. The overall success rate was significantly higher with the TruView compared than the MAC in scenario B (100 vs. 81.7 %; p = 0.011) and scenario C (100 vs. 68.3 %; p < 0.001). The intubation time was significantly lower with the TruView than the MAC (18.5 vs. 24.3 s, p = 0.017, for scenario A; 21.6 vs. 25.7 s, p = 0.023, for scenario B; and 28.9 vs. 45.4 s, p < 0.001, for scenario C). Glottic view quality was better with TruView than the MAC in all scenarios, p < 0.001.Conclusions: The TruView offers better intubation conditions than the MAC on a pediatric manikin in the control scenario, chest compression scenario, and chest compression scenario with cervical stabilization scenario. The TruView may be used to elevate the epiglottis for orotracheal intubation. Further clinical studies are necessary to confirm these initial positive findings.Trial Registration: clinicaltrials.gov Identifier: NCT02289872. What is Known: •Prehospital pediatric intubation using a standard laryngoscope is varied and ranges from 63.4 to 82 %. What is New: •This is the first study showing efficiency of pediatric endotracheal intubation using the TruView PCD by paramedics in tree simulation scenarios. •TruView PCD offers better pediatric intubation conditions than the Macintosh laryngoscope.
Highlights
Since the invention of the Macintosh and Miller laryngoscope blades in the 1940s, direct laryngoscopy (DL) has been considered as the Bgold standard^ of endotracheal intubation (ETI)
The TruView may be used to elevate the epiglottis for orotracheal intubation
The European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) recommend that chest compressions are continued and interruptions are minimized during CPR, and ETI during resuscitation should be performed quickly and efficiently by an experienced operator, while interruptions to chest compressions should be avoided where possible
Summary
Since the invention of the Macintosh and Miller laryngoscope blades in the 1940s, direct laryngoscopy (DL) has been considered as the Bgold standard^ of endotracheal intubation (ETI). According to scientific studies, the effectiveness of the ETI on children performed by paramedics using a standard laryngoscope in pre-hospital care is insufficient and ranges from 63.4 to 77 % [8, 9]. The ETI is considered the standard for securing the airway of severely ill or injured patients [1, 33]. According to current guidelines on the treatment of severely injured patients [2], emergency ETI should be performed immediately on all patients with a Glasgow Coma Scale (GCS)
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