Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study.

Abstract

The use of video laryngoscopes by novice physicians may improve first-pass success rates compared with direct laryngoscopy. The aim of the present study was to assess whether time to intubation, number of laryngoscopy attempts, and first-pass success rate during laryngoscopy with the video laryngoscope or conventional Macintosh laryngoscope are affected by personal protective equipment (PPE) donning. Seventy inexperienced physicians were randomly assigned to video laryngoscope or Macintosh groups and were instructed to perform intubation with both devices on a manikin, using PPE or a standard uniform. The primary outcomes were insertion time, number of laryngoscopy attempts, and first-pass success rates for each device with or without donning PPE. In the Macintosh group, significantly less time was needed for the first successful intubation without PPE vs. with PPE (12.17±3.69s vs. 24.07±5.09s, respectively; p<0.0001). On the other hand, such difference was not observed in the video laryngoscope group (14.99±3.01s vs. 14.01±3.35s, respectively; p=0.07). With PPE, the first-pass success rate was significantly higher in the video laryngoscope group [41 (58.6%) vs. 66 (94.3%), p<0.001]. The use of the video laryngoscope resulted in a significant decrease in insertion time compared with the Macintosh blade (14.01±3.35s vs. 24.07±5.09s, respectively; p<0.0001). First-pass success and insertion time with the video laryngoscope were not affected by PPE donning. However, both were negatively affected with the Macintosh laryngoscope.