Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Togay Evrin; Jacek Smereka; Damian Gorczyca; Szymon Bialka; Jerzy Robert Ladny; Burak Katipoglu; Lukasz Szarpak

doi:10.1155/2019/7306204

Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Emerg Med Int. 2019 Aug 20:2019:7306204. doi: 10.1155/2019/7306204. eCollection 2019.

Authors

Togay Evrin¹, Jacek Smereka², Damian Gorczyca³, Szymon Bialka⁴, Jerzy Robert Ladny⁵, Burak Katipoglu¹, Lukasz Szarpak³

Affiliations

¹ Department of Emergency Medicine, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, 06520 Cankaya, Ankara, Turkey.
² Department of Emergency Medical Service, Wroclaw Medical University, Parkowa 34, Wroclaw, Poland.
³ Medical Simulation Center, Lazarski University, Swieradowska 43, 02-662 Warsaw, Poland.
⁴ Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 3-go Maja 13-15, 41-800 Zabrze, Poland.
⁵ Department of Emergency Medicine and Disaster, Medical University Bialystok, Szpitalna 37, 15-295 Bialystok, Poland.

Abstract

Introduction: Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation.

Aim: The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model.

Methods: The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet.

Results: The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1^st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25-38); the time equalled 38s (IQR:31-44.5) in the standard bougie group and 47.5s (IQR:36-58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63-88), average in the standard bougie group (44, IQR:30-51), and highest in the new bougie stylet group (32, IQR:19-41).

Conclusion: In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.