Abstract
BackgroundEmergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS).MethodsALS EMTs were first shown a brief slideshow and three example videos and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed on the floor to simulate field intubation at the scene. Each participant was given up to three timed attempts with each technique. Endotracheal tube position was confirmed with visualization by one of the study authors. Comparisons and statistical analysis were conducted using SPSS® Statistics 21 (IBM®). Demographics and survey results were also collected and analyzed.ResultsThe median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997). Demographic factors including handedness and eye dominance did not seem to affect outcomes. Participants reported a relatively high level of satisfaction with the CVS.ConclusionsALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device. The CVS technique warrants further study for use as an alternative to DL and video laryngoscopy in the prehospital difficult airway scenario.
Highlights
Emergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning
For the purpose of this study, a difference in the total time of greater than or equal to 10 s would be considered the MCID. 3) advanced life support (ALS) emergency medical technician (EMT) will be satisfied with the Clarus Video System (CVS) and perceive it to be useful to their practice
Two participants required two attempts with the CVS and one participant used all three attempts and was unable to intubate with the CVS
Summary
Emergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS). Advanced life support (ALS) emergency medical technicians (EMTs) provide advanced airway management in the prehospital environment on a regular basis in most emergency medical services (EMS) systems in the United States and in many locations around the world where physicians are not the primary care provider. This study was designed to evaluate the ability of ALS EMTs to successfully intubate a normal airway in a simulated field environment with the CVS after providing only a brief introductory tutorial on the operation of the device. For the purpose of this study, a difference of one in number of attempts would be considered a minimal clinically important difference (MCID). For the purpose of this study, a difference in the total time of greater than or equal to 10 s would be considered the MCID. 3) ALS EMTs will be satisfied with the CVS and perceive it to be useful to their practice
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