title: Comparison of intubation modalities in a simulated cardiac arrest with uninterrupted chest compressions.
abstract: BACKGROUND
  Interruptions in chest compressions during cardiopulmonary resuscitation can negatively impact survival. Several new endotracheal intubation (ETI) techniques including video laryngoscopy may allow for ETI with minimal or no interruptions in chest compressions. We sought to determine the impact of three different ETI techniques upon time to intubation (TTI) in a simulated cardiac arrest during uninterrupted chest compression.
  
  
  METHODS
  We performed a randomised crossover study with a convenience sample of emergency physicians using three different ETI techniques: direct laryngoscopy (DL), GlideScope video laryngoscopy (GVL) and GlideScope video laryngoscopy with bougie (GVL-B). Providers performed ETI on a manikin on a hospital bed with concurrent chest compressions. Our primary outcome, TTI, was defined as the time from insertion of the laryngoscope blade until first breath. Given the correlated nature of the data, we used the paired t test to assess the differences in mean TTIs between GVL minus DL and GVL-B minus DL. We also ran the analysis stratified by provider experience.
  
  
  RESULTS
  We enrolled 20 providers with a median TTI (IQR) by device of: DL 27 s (20.3, 35.4), GVL 20.6 s (17.7, 27.1) and GVL-B 60.1 s (39.1, 99). The mean GVL-DL difference was -10.1 s (-17.9-2.3) while the mean GVL-B-DL difference was 45.6 s (19.8-71.4) (p<0.001). The GVL-B required the greatest TTI across providers of varying experience levels.
  
  
  CONCLUSIONS
  In this simulated model of cardiac arrest with uninterrupted chest compressions, TTI was shorter for GVL than DL while use of the GVL with bougie resulted in longer TTI.
authors.affiliation: Department of Medicine, Division of Emergency Medicine, Saint Vincent Health System, Erie, Pennsylvania, USA.
authors.forename: Navin
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Department of Medicine, Division of Emergency Medicine, Saint Vincent Health System, Erie, Pennsylvania, USA Department of Medicine, Division of Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: McCarthy
authors.affiliation: Department of Medicine, Division of Emergency Medicine, Saint Vincent Health System, Erie, Pennsylvania, USA Department of Medicine, Division of Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Forehand
authors.affiliation: Department of Medicine, Division of Emergency Medicine, Saint Vincent Health System, Erie, Pennsylvania, USA Department of Medicine, Division of Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008348:Manikins; D013997:Time Factors; D014741:Video Recording
keywords: Airway