Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial.

Leszek Gadek,Frank William Peacock,Marek Dabrowski,Lukasz Iskrzycki,Jacek Smereka,Wiktoria Laura Drela,Maciej Maslanka,Szymon Bialka,Marta Jachowicz,Lars Konge,Lukasz Szarpak,Dominika Telecka-Gadek

doi:10.3390/jcm10245740

Abstract

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

Highlights

Introduction conditions of the Creative CommonsAirway management is a key element of the resuscitation process but the first-pass success of emergency intubations are inconsistent and relatively low
Fifty-four active paramedics (31% female) with a median of 5.3 years (IQR: 3–11) of experience in Emergency Medical Service Teams participated in this trial
17 (IQR: 12–35) intubations and none had any experience with any video laryngoscope

Summary

Introduction

Airway management is a key element of the resuscitation process but the first-pass success of emergency intubations are inconsistent and relatively low. According to the guidelines of the American Heart Association (AHA), a safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support cardiac arrest algorithm for suspected or confirmed COVID19 patients [7]. This is because the new SARS-CoV-2 coronavirus is mainly transmitted by air [8,9], and the airway protection procedure itself is considered a high-risk aerosolgenerating procedure (AGP) in COVID-19 [10]

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