Success Rate Of Intubation Research Articles

Perbandingan Keberhasilan Intubasi pada Upaya Pertama antara Video Laryngoscope dengan Direct Laryngoscope

This study aims to determine differences in the success of intubation on the first attempt between video laryngoscopes and direct laryngoscopes. The method used is an experimental quasi-experimental type with a Two Group Post Test Design. The sampling technique was carried out by consecutive sampling with the research instrument, namely the observation sheet. Data were collected in the operating room of Prof. Dr. R. D. Kandou Manado with a sample size of 40 respondents, with 20 respondents intubating with a direct laryngoscope and 20 respondents intubating with a video laryngoscope using an unpaired t-test. The results showed that the probability value obtained was 0.035. In conclusion, the success rate of intubation on the first attempt with a video laryngoscope is higher than that of a direct laryngoscope.
 
 Keywords: Direct Laryngoscope, Intubation, Video Laryngoscope

Comparison of clinical performance of Ambu® AuraGain™ and BlockBuster® in anaesthetised preschool children-A randomised controlled trial.

Supraglottic airway (SGA) devices are a boon to paediatric airway management. The clinical performances of the BlockBuster® laryngeal mask airway (LMA) and Ambu® AuraGain™ in preschool children were compared in this study. After ethical approval and trial registration, this randomised controlled study was conducted on 50 children, aged 1-4 years, randomised into two groups. Appropriate sized Ambu® AuraGain™ (group A) and LMA BlockBuster® (group B) were placed as per the manufacturer's recommendation under general anaesthesia. Appropriate size of the endotracheal tube was then chosen and inserted through the device. Primary objective of the study was to compare the oropharyngeal seal pressure (OSP), and secondary objectives were the first attempt intubation success rate, overall intubation success rate, SGA insertion time, intubation time, haemodynamic changes and postoperative pharyngolaryngeal complications. The Chi-square test was used to analyse the categorical variables, while the intragroup comparison of mean changes in outcomes was evaluated by the unpaired t-test. The level of significance was set at P < 0.05. Demographic parameters were uniformly distributed in both the groups. The mean OSP in group A was 26.6 ± 0.95 cm H2O and in group B was 29.08 ± 0.75 cm H2O. Both the devices were successfully inserted in all the patients. The success rate of blind endotracheal intubation through the device in first attempt was 4% in group A and 80% in group B. Postoperative pharyngolaryngeal complications were relatively less in group B. LMA BlockBuster® provides higher OSP and provides a higher success rate of blind endotracheal intubation in paediatric patients.

Comparison of Ease and Success of Intubation through LMA Blockbuster and Ambu Aura-I in Patients Receiving General Anesthesia

Background: Airway gadgetry is expanding at an exponential rate. It is imperative to understand the intubating characteristics of supraglottic devices so that the choice of device in patients is based on evidence rather than just the design. The present study was conducted to compare blind intubation with blockbuster LMA and Ambu Aura-i. Methodology: Sixty patients of either sex, 20 to 60 years of age, ASA I–III, scheduled to undergo elective surgery under general anesthesia, were included in this prospective, randomized, comparative study. Group A (n = 30) patients were intubated with AmbuAura-i, and Group B (n = 30) patients were intubated using BlockBuster LMA. Results: Endotracheal intubation was found easy in 76% of the patients and difficult in 10% of the patients intubated with Ambu Aura −i. A 13.3% failure rate was observed in group A. Intubation success rate of 100% was observed in Group B. 86.6% of patients were easily intubated, and seven patients were intubated with a bit of difficulty (P-value 0.010). The mean time of SGD insertion in Group A was 14.77 ± 5.563 seconds, and in Group B was 21.87 ± 7.186 seconds (P-value 0.000). SGD insertion attempts were significantly higher in Group B when compared to Group A (P-value 0.025). Conclusion: Although AA-i requires less time for the placement of SGD, blockbuster LMA remains the better choice with a 100% success rate of blind orotracheal intubation.

Comparison of C-MACTM Videolaryngoscope with Macintosh Laryngoscope in Anticipated Difficult Airway

Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.

We must not sacrifice anaesthesia rotations as part of emergency medicine training.

We must not sacrifice anaesthesia rotations as part of emergency medicine training.

Micropipette tip intubation in rats as a replacement for conventional endotracheal tube intubation.

Endotracheal intubation is often necessary in the course of animal experiments, especially in craniofacial surgery. However, endotracheal intubation can be a major burden in this context. The authors performed simple and cost-saving method using a 200 μL yellow micropipette tip, and the success of this method was demonstrated by X-ray and autopsy. We used a total of 30 rats. After the rats were fixed with a plaster, the trachea and vocal cords were visualized with the tongue pulled back. Under direct visualization of the vocal cords, a curving micropipette tip was advanced into the trachea. This method can be learned quickly and applied successfully by general experimenters. We successfully intubated all 30 rats without any complications. The success rate of micropipette tip intubation was 100%. This procedure was performed by one experimenter within 2 to 3 minutes after induction of anesthesia. We demonstrated its superiority by X-ray and autopsy. Herein, we describe endotracheal intubation of rats using micropipette tips. To the best of our knowledge, this method is novel and represents the simplest and most efficient means of intubation in rats, providing an alternative to conventional endotracheal intubation.

Comparing the learning curve of laryngoscopy using macintosh laryngoscope with or without video assistance for tracheal intubation by novices after manikin training

ObjectiveNo studies in the literature have compared video-assisted MacIntosh laryngoscope with conventional MacIntosh laryngoscope in teaching tracheal intubation to novices. Hence, we conducted a randomized controlled trial to compare the learning curve of direct MacIntosh laryngoscope with and without video assistance for tracheal intubation by novices after manikin training. MethodsTwelve novices were included in the study. Out of 12, six novices were taught tracheal intubation on manikin using a MacIntosh laryngoscope, and the other six using a video-assisted MacIntosh laryngoscope. In Group ML(n = 30), novices trained with MacIntosh laryngoscope performed tracheal intubation in 5 patients, each using the same device. In Group VML(n = 30), novices who were acquainted with video-assisted MacIntosh laryngoscope performed tracheal intubation in 5 patients, each using the same device. ResultsThe percentage of 0, ≤5, and >5 Intubation difficulty scale (IDS) were 0.00%, 43.33%, and 56.67% in Group ML and 0.00%, 80.0%, and 20.00% in Group VML, respectively. The success rate of performing tracheal intubation in Group ML was 40.00%(12/30), and the success rate of Group VML was 70.00%(21/30). The difference in the IDS score and success rate of intubation were found to be statistically significant. The mean intubation time was 93.77 ± 15.80 s in Group ML and 92.33 ± 19.06 s in Group VML. The visualization of the glottis by Cormack Lehane grading (CLG) in Group ML(n = 30) was grade I in 14(46.67%) patients and grade II in 16(53.33%) patients. In Group VML (n = 30), CLG grade I accounted for 18(60.00%) patients, grade II in 12(40%) patients. The intubation time and CLG were statistically insignificant between the two groups. ConclusionNovices trained and performed tracheal intubation with video-assisted MacIntosh laryngoscope had a greater success rate on the first attempt and lower IDS score than those trained with MacIntosh laryngoscope.

Comparison of the Intubation Success Rate in Video Laryngoscopy versus Direct Laryngoscopy in Patients with Philadelphia Collar: A Randomized Clinical Trial

Background: Video laryngoscopy (VL) and direct laryngoscopy (DL) are two approaches to provide secure airway for patients with compromised airways. This study aims to compare the intubation success rate in video laryngoscopy versus direct laryngoscopy in patients with Philadelphia collars.&#x0D; Methods: 172 patients with cervical collars who have undergone general anesthesia were enrolled. After induction of anesthesia for all patients, an oral airway was used to facilitate the ventilation. A VL approach in Group A and DL approach in Group B were used. In order to evaluate the effectiveness of each method, we considered related parameters, including intubation time, the number of intubation attempts, Cormack-Lehane (CL) score, orodental injuries, heart rate, and blood pressure 3 minutes after intubation, oxygen saturation, neck circumference, and BMI.&#x0D; Results: The ratio of first-attempt intubations was not different among the two groups (P = 1.00). The mean [SD] time for intubation was shorter with DL vs VL (p&lt;0.0001). There were almost equal rates of CL grades 1 and 2 (67.5% and 29%) using the VL than with the. The mean [SD] mean arterial pressure in VL vs DL was 86.17 mmHg vs 90.88 mmHg (p = 0.086).&#x0D; Conclusion: According to our results, there was no significant difference in complications and hemodynamic changes after intubation in both groups, but the intubation duration was significant shorter in DL group.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

The aerosol box has been used during the management of patients with COVID-19 to reduce health care practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs). Little is known about the effect of aerosol box use on HCP contamination and AGMP procedure time. To investigate whether use of an aerosol box during AGMPs reduces HCP contamination or influences the time to successful completion and first-pass success rate for endotracheal intubation (ETI) and laryngeal mask airway (LMA) insertion. This multicenter, simulation-based, randomized clinical trial was conducted from May to December 2021 at tertiary care pediatric hospitals. Participant teams performed 3 simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. During the scenarios, aerosols were generated using Glo Germ. Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Statistical analysis was performed from July 2022 to February 2023. The aerosol box (or SplashGuard CG) is a transparent, plastic barrier covering the patient's head and shoulders with access ports allowing HCPs to manage the airway. The primary outcome was surface area of contamination (AOC) on participants. Secondary outcomes were time to successful completion and first-pass success rates for ETI and LMA insertion. A total of 64 teams (128 participants) were enrolled, with data from 61 teams (122 participants) analyzed. Among the 122 participants analyzed, 79 (64.8%) were female and 85 (69.7%) were physicians. Use of an aerosol box was associated with a 77.5% overall decreased AOC to the torso (95% CI, -86.3% to -62.9%; P < .001) and a 60.7% overall decreased AOC to the facial area (95% CI, -75.2% to -37.8%; P < .001) in airway HCPs. There was no statistically significant difference in surface contamination after doffing personal protective equipment between groups. Time to completing ETI was longer in the aerosol box group compared with the control group (mean difference: 10.2 seconds; 95% CI, 0.2 to 20.2 seconds; P = .04), but there was no difference between groups for LMA insertion (mean difference: 2.4 seconds; 95% CI, -8.7 to 13.5 seconds; P = .67). In this randomized clinical trial of aerosol box use in AGMPs, use of an aerosol box reduced contamination deposition on HCPs' torso and face predoffing; the use of an aerosol box delayed time to successful intubation. These results suggest that the incremental benefits of reduced surface contamination from aerosol box use should be weighed against delayed time to complete intubation, which may negatively affect patient outcome. ClinicalTrials.gov Identifier: NCT04880668.

Use of video laryngoscopy versus direct laryngoscopy as a teaching tool for neonatal intubation: A systematic review.

Endotracheal intubation and positive pressure ventilation following delivery are required in 32.9% of neonates <31 weeks gestational age and in 5.9% of older newborn babies [1]. Competency in intubation is important, yet opportunities for learners to develop this skill in the clinical environment are limited. Direct laryngoscopy (DL) provides a direct view of the airway during intubation. Unfortunately, visualization of the airway is only available to the primary operator, preventing supervising instructors from simultaneously viewing the airway and allowing them to provide real-time feedback to learners. Video laryngoscopy (VL) is a specialized clinical instrument that utilizes an indirect view of the airway that is digitally projected onto a screen via camera, which allows multiple simultaneous viewers to view the airway during intubation attempts and permits instructors to provide real-time feedback to learners accordingly. This systematic review explores whether VL-supported learning is superior to DL for the development of skill in neonatal intubation. Systematic searches of MEDLINE, EMBASE, CINAHL and the Cochrane Library were conducted without language restrictions. Studies published between January 2011 and November 2021 were examined. Randomized controlled trials (RCTs) comparing the effectiveness of VL versus DL for supporting neonatal intubation learning were included. Rate of successful intubation was the primary outcome measure. Both authors independently extracted study data and conducted risk of bias assessment. Four RCTs met the inclusion criteria, with two incorporating crossover designs. Each examined the effectiveness of VL versus DL, with concurrent supervisor support, as a tool for learning neonatal intubation in medical residents. All studies reported significantly higher intubation success rates with VL. VL and real-time supervisor feedback is a more effective tool for supporting the development of neonatal intubation skill, compared with DL. Future investigations should include learners from other professions whose scope of practice includes neonatal intubation (eg, respiratory therapists).

Videolaryngoscopy as a primary intubation modality in obstetrics: A narrative review of current evidence.

Pregnancy-related physiologic and anatomic changes affect oxygenation and airway management, and it is widely believed that airway difficulty may be more common in obstetric patients as a result. In addition, most obstetric intubations are performed under emergency conditions, and preoperative airway assessment poorly predicts airway management outcomes. These considerations necessitate special protocols for airway care in the obstetric population, and the evolution of the videolaryngoscope represents one of the most important milestones in recent decades. However, recommendations for the use of videolaryngoscopy in obstetrics remain unclear. A considerable body of evidence affirms that videolaryngoscopy improves laryngeal visualisation, increases first-attempt and overall intubation success rates, shortens intubation time, and facilitates team communication and education. In contrast, a significant number of studies have also reported conflicting results regarding comparative clinical outcomes and have highlighted other limitations regarding the adoption of videolaryngoscopy in routine obstetric care. Nevertheless, considering the peculiarities of obstetric intubation, the Macintosh-style videolaryngoscope can be suggested as the primary intubation device as it offers the benefits of both videolaryngoscopy and direct laryngoscopy. However, more rigorous evidence is needed to clarify the current blind spots and controversies regarding the role of videolaryngoscopy in obstetrics.

COMPARISON BETWEEN C-MAC VIDEOLARYNGOSCOPE V/S MACINTOSH LARYNGOSCOPE FOR INTUBATION IN EMERGENCY ICU

Introduction: The incidence of difcult endotracheal intubation is high in the ICU because of various factors. Most commonly used method for endotracheal intubation is direct laryngoscopy. Video Laryngoscopes are also helpful aids which provide a better laryngeal view in comparison to Direct Laryngoscope. We should aim at minimizing the time required to achieve a secure airway for ventilation in patients presenting to the Emergency Department/ICU. This was a prospective randomized study in Emer Methods : gency ICU in a tertiary care hospital. A total of 90 patients requiring endotracheal intubation in Emergency ICU were included in the study and were randomly divided into two groups. Group A included patients intubated with the help of C-MAC Videolaryngoscope and Group B included patients intubated with Macintosh Laryngoscope. The primary outcome was to determine overall successful intubation rates. Secondary outcome was to measure rst attempt successful intubation rates, time to intubation, requirement of External Laryngeal Manipulation, requirement of any intubating aids. Patients in Group A and Results : Group B showed an overall similar intubation success rate (p=0.213). Rate of rst attempt intubation in Group A and Group B was similar (p=0.120). Average time to intubation with Group A and Group B was also similar (p=0.0647). Requirement of ELM was lesser with Group A as compared to Group B (p=0.038). The requirement of use of intubating aids was lesser in Group A vs Group B (p=0.003). The use of C- Conclusion : MAC video laryngoscope provided better glottis visualization but resulted in similar rst attempt intubation rates, almost similar time to intubation. C-MAC group required lesser overall requirement of ELM and use of intubating aids when compared to the Macintosh Laryngoscope. Thus, C-MAC® Videolaryngoscopy seems to be a useful technique as the initial approach for endotracheal intubation in the ICU.

Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath).

Objective. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. Design. A crossover manikin study. Settings. University-affiliated hospital. Participants. Forty-two novice medical students unfamiliar with DLT intubation. Interventions. Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). Measurements and Main Results. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (P < 0.044 and P < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (P < 0.011 and P < 0.002, respectively) in the simulated "easy" and "difficult" over most of the intubation attempts. In the simulated "easy" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], P = 0.012). Conclusion. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated "easy" and "difficult" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.

Effect of inclined positioning on first-pass success during endotracheal intubation: a systematic review and meta-analysis

BackgroundEndotracheal intubation is a high-risk procedure. Optimisation of all aspects of the procedure, including patient positioning, is important to facilitate success and minimise complications. The objective of this systematic review...

Acute epiglottitis caused by COVID-19: A systematic review.

The COVID-19 pandemic has caused substantial population infections worldwide. COVID-19 has been reported to cause acute epiglottitis (AE); nonetheless, COVID-19-related AE is poorly understood by healthcare workers because of the disease's low occurrence. This systematic review aimed to improve knowledge of the clinical characteristics of COVID-19-related AE. We conducted a comprehensive search of the literature databases PubMed, Web of Science, Embase, and Scopus, using various keywords and descriptors such as "COVID-19," "SARS-CoV-2," and "AE" in combination with the AND/OR operator. This review included 11 patients with COVID-19-related AE, all of whom were adults except for one 15-year-old girl. COVID-19-related AE was more prevalent in males, who accounted for 81.8% of patients. Patients with COVID-19-related AE experienced symptoms such as hoarseness, dysphagia, odynophagia, sore throat, and dyspnea. Hoarseness may be one of the typical symptoms of COVID-19-related AE. Five patients with COVID-19-related AE had coexisting diseases, including hypertension, obesity, diabetes, obstructive sleep apnea, Wolff-Parkinson-White syndrome, and intracranial tumors. Antibiotics and steroids were commonly administered. Five patients with COVID-19-related AE underwent intubation and cricothyroidotomy airway management. Due to the low success rate of intubation, emergency tracheotomy is the recommended option for patients with COVID-19-related AE who present with more severe dyspnea. AE could be an uncommon manifestation of COVID-19, and SARS-CoV-2 infection should be considered as a possible cause of AE. Healthcare workers should be vigilant in recognizing COVID-19-related AE.

A Randomized Controlled Trial: Examining the Impact of the Novel Double Setup Endotracheal Tube on the Success Rates of Awake Fiber-Optic Orotracheal Intubation

Background: Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiber-optic intubation (AFOI) is often impeded. Various maneuvers and tracheal tubes designed to overcome this obstruction may also be unsuccessful or costly. Objective: The current study aimed to assess how the novel double configuration ETT affected AFOI success rates on the first attempt. Methods: A randomized controlled experiment including 40 individuals receiving awake fiber-optic orotracheal intubation was performed in a 1:1 ratio with a single ETT railroaded with its bevel posteriorly (ST) or railroading with a double setup ETT (DT) over a flexible videoscope (FVS) for tracheal intubation. The number of intubation attempts, time spent intubating, and adverse events were examined and compared between the two groups. Results: Twenty patients received a single ETT railroaded with the bevel posteriorly, and 20 patients received railroading with the double setup ETT during AFOI. Intubation on the first attempt was significantly greater in the DT group (90%) than in the ST group (35%). The intubation time was considerably shorter for the DT group (12.8 [7.8–16.9] s) when compared with the ST group (27.9 [16.3–91.0] s). Five patients were intubated by the alternative technique after failure to intubate for several attempts, and 3 cases were found to have a crease in the FVS after intubation in group ST. During topical anesthetic, three individuals in each group experienced transient oxygen desaturation. Conclusions: Our study discovered that the novel double setup tube could significantly improve the intubation success rate on the first attempt during AFOI for patients with challenging airway when a strategy based on a reduced gap between ETT and FB could not be applied.

Development and evaluation of an anatomically designed and 3D printed device to enhance orotracheal intubation success in rabbits by inexperienced veterinarians

ObjectiveTo assess whether the use of a three-dimensional (3D) printed device enhances the success rate of orotracheal intubation in rabbits. Study designProspective, crossover randomized controlled trial. AnimalsA total of six mixed-breed rabbits. MethodsA device to guide the endotracheal tube was designed based on computed tomography images and then manufactured using 3D printing. Rabbits were randomly assigned for intubation by two inexperienced veterinarians using the blind (BLI), borescope- (BOR) or device- (DEV) guided techniques. Success rate, number of attempts, time to success, injury scores and propofol dose were recorded and compared. Significance was considered when p < 0.05. ResultsSuccess rate was higher in DEV (58.3%) than in BLI (8.3%) (p < 0.023), but not different from that in BOR (41.6%). Total time until successful intubation was lower in DEV (45 ± 23 seconds) and BOR (85 ± 62 seconds) than in BLI (290 seconds; p < 0.006). Time for the successful attempt was lower for DEV (35 ± 10 seconds) and BOR (74 ± 43 seconds) than in BLI (290 seconds; p < 0.0001). The propofol dose required was lower for DEV (2.3 ± 1.2 mg kg–1) than for BLI (3.4 ± 1.6 mg kg–1) (p < 0.031), but not different from BOR (2.4 ± 0.9 mg kg–1). Number of attempts and oxygen desaturation events were not different among techniques (p < 0.051 and p < 0.326, respectively). Injury scores [median (range)] before and after attempts were different in BLI [0 versus 1 (0–3), p < 0.005] and BOR [0 (0–1) versus 1 (0–3), p < 0.002] but not in DEV [0 (0–2) versus 0 (0–3), p < 0.109]. Conclusions and clinical relevanceThe device facilitated orotracheal intubation with a time similar to the borescope-guided technique but faster than the traditional blind technique.

Does Cricoid Pressure Increase the Laryngoscopy Force During Rapid Sequence Induction?-A Randomized Study.

Cricoid pressure, a manoeuver used to prevent pulmonary aspiration during rapid sequence induction, can result in deterioration of laryngeal view and increased haemodynamic changes. Its effect on laryngoscopy force remains unevaluated. The study aimed to assess the impact of cricoid pressure on laryngoscopy force and intubation characteristics during rapid sequence induction. Seventy American Society of Anaesthesiologists I/II patients, both sexes, aged 16-65, having non-obstetric emergency surgery were randomly assigned to the cricoid group, which received 30 N cricoid pressure during rapid sequence induction, and the sham group, which received 0 N pressure. Propofol, fentanyl, and succinylcholine were used to produce general anaesthesia. The primary outcome was the peak force of laryngoscopy. Secondary outcomes were the laryngoscopic view, time to execute endotracheal intubation, and intubation success rate. With the application of cricoid pressure, the peak forces of laryngoscopy increased significantly, with a mean difference (95% CI) of 15.5 (13.8-17.2) N. With and without CP, the mean peak forces were 40.758 (4.2) and 25.2 (2.6) N, respectively, P < .001. Without cricoid pressure, the intubation success rate was 100%, compared to 85.7% with cricoid pressure, P = .025. The proportions of CL1/2A/2B patients with and without cricoid pressure were 5/23/7 and 17/15/3, respectively, with P = .005. With cricoid pressure, there was a considerable increase in intubation duration, with a mean difference (95% CI) of 24.4 (2.2-19.9) seconds. Cricoid pressure increases peak forces during laryngoscopy, resulting in worse intubation characteristics. This demonstrates the need of exercising care while performing this manoeuver.

The effect of a multi-faceted quality improvement program on paramedic intubation success in the critical care transport environment: a before-and-after study

IntroductionEndotracheal intubation (ETI) is an infrequent but key component of prehospital and retrieval medicine. Common measures of quality of ETI are the first pass success rates (FPS) and ETI on the first attempt without occurrence of hypoxia or hypotension (DASH-1A). We present the results of a multi-faceted quality improvement program (QIP) on paramedic FPS and DASH-1A rates in a large regional critical care transport organization.MethodsWe conducted a retrospective database analysis, comparing FPS and DASH-1A rates before and after implementation of the QIP. We included all patients undergoing advanced airway management with a first strategy of ETI during the time period from January 2016 to December 2021.Results484 patients met the inclusion criteria during the study period. Overall, the first pass intubation success (FPS) rate was 72% (350/484). There was an increase in FPS from the pre-intervention period (60%, 86/144) to the post-intervention period (86%, 148/173), p < 0.001. DASH-1A success rates improved from 45% (55/122) during the pre-intervention period to 55% (84/153) but this difference did not meet pre-defined statistical significance (p = 0.1). On univariate analysis, factors associated with improved FPS rates were the use of video-laryngoscope (VL), neuromuscular blockage, and intubation inside a healthcare facility.ConclusionsA multi-faceted advanced airway management QIP resulted in increased FPS intubation rates and a non-significant improvement in DASH-1A rates. A combination of modern equipment, targeted training, standardization and ongoing clinical governance is required to achieve and maintain safe intubation by paramedics in the prehospital and retrieval environment.

Usability testing of a blind intubation device for intubation novices: a randomized crossover simulation study.

A new blind intubation device (BID) has been developed for endotracheal intubation. This study aimed to test the usability of the BID in comparison to direct laryngoscopy (DL) and video laryngoscopy (VL) with inexperienced healthcare providers for endotracheal intubation. This was a randomized crossover simulation study. Participants who had conducted fewer than five live intubation sessions were included in the study. The manikin simulation was conducted using a Laerdal trainer airway manikin. Participants performed intubation using all three devices, DL, VL, and BID. The primary outcome was intubation success rate in the first pass the secondary outcome was intubation time to first ventilation, and the tertiary outcome was dental injury. A total of 45 healthcare workers who were novices in intubation participated in this study, including 13 physicians (interns), 14 emergency medical technicians, and 18 nurses. The intubation success rates in the first pass with BID, DL, and VL were 93.3%, 91.1%, and 97.8%, respectively (P=0.53). The intubation times to first ventilation with BID, DL, and VL were 13.15±6.16, 19.07±7.71, and 17.31±6.57 seconds, respectively (P<0.01). The proportions of dental injuries associated with BID, DL, and VL were 0% for physicians; 28.6%, 14.3%, and 0%, respectively for emergency medical technicians; and 27.8%, 11.1%, and 16.7%, respectively for nurses. We performed a pilot study to test the usability of the new BID. There was no significant difference in intubation success rate in the first pass among BID, DL, and VL. The intubation time to first ventilation was shorter with the BID compared to DL and VL.