Abstract
BackgroundVideolaryngoscopy (VL) has become a popular method of intubation (ETI). Although VL may facilitate ETI in less-experienced rescuers there are limited data available concerning ETI performed by paramedics during CPR. The goal was to evaluate the impact VL compared with DL on intubation success and glottic view during CPR performed by German paramedics. We investigated in an observational prospective study the superiority of VL by paramedics during CPR compared with direct laryngoscopy (DL).MethodsIn a single Emergency Medical Service (EMS) in Germany with in total 32 ambulances paramedics underwent an initial instruction from in endotracheal intubation (ETI) with GlideScope® (GVL) during resuscitation. The primary endpoint was good visibility of the glottis (Cormack-Lehane grading 1/2), and the secondary endpoint was successful intubation comparing GVL and DL.ResultsIn total n = 97 patients were included, n = 69 with DL (n = 85 intubation attempts) and n = 28 VL (n = 37 intubation attempts). Videolaryngoscopy resulted in a significantly improved visualization of the larynx compared with DL. In the group using GVL, 82% rated visualization of the glottis as CL 1&2 versus 55% in the DL group (p = 0.02). Despite better visualization of the larynx, there was no statistically significant difference in successful ETI between GVL and DL (GVL 75% vs. DL 68.1%, p = 0.63).ConclusionsWe found no difference in Overall and First Pass Success (FPS) between GVL and DL during CPR by German paramedics despite better glottic visualization with GVL. Therefore, we conclude that education in VL should also focus on insertion of the endotracheal tube, considering the different procedures of GVL.Trial registrationGerman Clinical Trial Register DRKS00020976, 27. February 2020 retrospectively registered.
Highlights
Videolaryngoscopy (VL) has become a popular method of intubation (ETI)
We investigated the impact of using videolaryngoscopy (VL) instead of direct laryngoscopy (DL) by paramedics in out-of-hospital cardiac arrest before arrival of the emergency physician on scene in a semi-rural county in Germany
Paramedics’ professional experience in years (7 yrs. in DL vs 6.5 yrs. in GlideScope® videolaryngoscopy (GVL), p = 0.48) and the estimated number of conventional (DL) intubations (n = 30 DL vs n = 22.5 GVL, p = 0.14) performed previously by the paramedics were similar in both groups
Summary
Videolaryngoscopy (VL) has become a popular method of intubation (ETI). VL may facilitate ETI in less-experienced rescuers there are limited data available concerning ETI performed by paramedics during CPR. Emergency medical services (EMS) in Germany is designed as a two-tiered system including a physician-staffed EMS unit in all lifethreatening cases and an ALS-Ambulance with paramedics. As soon as the emergency physician is on scene, procedures such as endotracheal Intubation (ETI) are performed by the physician. Due to the higher availability of paramedic-staffed ambulances, in many cases the paramedics are on scene before the arrival of the EMS physician. Paramedics are trained in ALS including direct laryngoscopy and endotracheal intubation, the rate of performing endotracheal intubation by paramedics before the arrival of the emergency physician unit is low. We investigated the effect of VL compared to DL by paramedics during CPR before arrival of the emergency physician on both visibility of the glottis and intubation success rate
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