Comparison of video, optical, and direct laryngoscopy by experienced tactical paramedics.
OBJECTIVE
While optical and video laryngoscopy have been studied in the emergency department, the operating room, and the routine prehospital setting, their efficacy in the tactical environment--in which operator safety is as important as intubation success--has not been evaluated. This study compared direct laryngoscopes to optical (AirTraq) and video (King Vision) laryngoscopes in a simulated tactical setting.


METHODS
This prospective institutional review board-approved simulation study evaluated each of the laryngoscopes in the hands of seven experienced tactical paramedics. After a one-hour training session, each tactical paramedic used each of the laryngoscopes, in a random order, on each of four different airway manikins. A tactical environment was simulated using auditory and visual immersion, and the intubations occurred on the ground with the paramedics in full tactical gear. Outcomes included time to successful ventilation, first-pass success rate, Cormack-Lehane grade, and intubator head height during the intubation. Statistical analysis included chi-squared and Wilcoxon rank sum tests, and multivariate logistic regression was performed to determine contributing factors to outcomes with significant variation.


RESULTS
A total of 84 intubations were performed by seven tactical paramedics. While there were no significant differences in time to successful ventilation or first-pass success rate, the optical and video laryngoscopes had significantly better Cormack-Lehane grades, defined as grade I or II (100% for both compared to 85.7%), while direct laryngoscopy resulted in significantly less maximum vertical exposure of the intubator (51.82 cm compared to AirTraq's 56.64 cm and King Vision's 56.13 cm).


CONCLUSIONS
Video and optical laryngoscopes can be used successfully by experienced tactical paramedics in a simulated tactical setting. The King Vision and AirTraq resulted in improved Cormack-Lehane glottic views but similar times to ventilation and first-pass success compared to direct laryngoscopy. Intubator head height was lower with direct laryngoscopy. Clarifying the role of optical and video laryngoscopes in a tactical environment, especially in the hands of less experienced intubators, requires further research.
Brian J
BJ
Yun
Calvin A
CA
Brown
Christopher J
CJ
Grazioso
Charles N
CN
Pozner
Ali S
AS
Raja
D000328:Adult; D000488:Allied Health Personnel / Q000193:education*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000193:education* / Q000295:instrumentation; D016015:Logistic Models; D008297:Male; D008348:Manikins; D008875:Middle Aged; D015999:Multivariate Analysis; D055096:Optical Devices; D011446:Prospective Studies; D014741:Video Recording
airway management; intubation; simulation; tactical medicine; video laryngoscopy