Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial

Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI).

Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-view^TM VL, UESCOPE^® VL, ProVu^® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions.

Results: The longest IT was noted when the UESCOPE^® (29.4 s) and ProVu^® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu^®, UESCOPE^® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE^® and ProVu^®.

Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE^® and ProVu^® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.