Ability of paramedics to perform endotracheal intubation during continuous chest compressions: a randomized cadaver study comparing Pentax AWS and Macintosh laryngoscopes

Am J Emerg Med. 2016 Sep;34(9):1835-9. doi: 10.1016/j.ajem.2016.06.054. Epub 2016 Jun 16.

Abstract

Objective: The aim of the trial was to compare the time parameters for intubation with the use of the Macintosh (MAC) laryngoscope and Pentax AWS-S100 videolaryngoscope (AWS; Pentax Corporation, Tokyo, Japan) with and without chest compression (CC) by paramedics during simulated cardiopulmonary resuscitation in a cadaver model.

Methods: This was a randomized crossover cadaver trial. Thirty-five paramedics with no experience in videolaryngoscopy participated in the study. They performed intubation in two emergency scenarios: scenario A, normal airway without CC; scenario B, normal airway with continuous CC.

Results: The median time to first ventilation with the use of the AWS and the MAC was similar in scenario A: 25 (IQR, 22-27) seconds vs. 24 (IQR, 22.5-26) seconds (P=.072). A statistically significant difference in TTFV between AWS and MAC was noticed in scenario B (P=.011). In scenario A, the first endotracheal intubation (ETI) attempt success rate was achieved in 97.1% with AWS compared with 94.3% with MAC (P=.43). In scenario B, the success rate after the first ETI attempt with the use of the different intubation methods varied and amounted to 88.6% vs. 77.1% for AWS and MAC, respectively (P=.002).

Conclusions: The Pentax AWS offered a superior glottic view as compared with the MAC laryngoscope, which was associated with a higher intubation rate and a shorter intubation time during an uninterrupted CC scenario. However, in the scenario without CC, the results for AWS and MAC were comparable.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cadaver
  • Cardiopulmonary Resuscitation / methods*
  • Clinical Competence*
  • Cross-Over Studies
  • Emergency Medical Technicians
  • Equipment Design
  • Female
  • Heart Massage / methods*
  • Humans
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Laryngoscopes*
  • Laryngoscopy
  • Male
  • Video Recording
  • Young Adult