Direct versus video laryngoscopic intubation by novice prehospital intubators with and without chest compressions: A pilot manikin study

OBJECTIVES: To evaluate whether chest compressions affect the time taken for intubation (TTI) using the Macintosh laryngoscope and two portable video laryngoscopes (VLs) (GlideScope Ranger and Airway Scope) when used by novice prehospital caregivers, and to compare the TTIs and rates of successful intubation among the three laryngoscopes with and without chest compressions in a manikin model. METHODS: This was a pilot randomized crossover study. Twenty paramedic students and paramedics who had no clinical experience with tracheal intubation and had never used any of two VLs participated in the study. After a one-hour training session for the VLs, participants performed intubations on a Laerdal Resusci Anne Simulator placed on the floor. Each paramedic used all three laryngoscopes, with the order of usage being randomly assigned. The TTIs and rates of successful intubation among the three laryngoscopes, with and without ongoing chest compressions, were compared. RESULTS: The difference between the TTIs using each laryngoscope with and without chest compressions was not significant (Macintosh: 2.99 sec, p = 0.06; GlideScope Ranger: 2.04 sec, p = 0.11; and Airway Scope: 0.91 sec, p = 0.10). The median TTI using the Airway Scope (15.46 sec) was significantly shorter than those for the Macintosh (24.14 sec) and the GlideScope Ranger (24.12 sec) during chest compressions (p = 0.028 and p = 0.004, respectively). There were no significant differences in the rates of successful intubation among the three laryngoscopes on each condition (without chest compressions, p = 0.15; with chest compressions, p = 0.27), but the cumulative success rates related to the TTI were significantly greater with the Airway Scope than with the other devices in both conditions. CONCLUSION: In this pilot study, chest compressions did not significantly affect the TTI using the Macintosh laryngoscope and two portable VLs when used by novice prehospital caregivers in the manikin model on the floor. Considering the fairly short training time, two portable VLs may be potentially useful adjuncts for tracheal intubation during chest compressions for novice prehospital caregivers. Further studies are required to validate whether these findings are clinically relevant.ope