Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial.
BACKGROUND
Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR.


METHODS
One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation.


RESULTS
The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively.


CONCLUSIONS
Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: lukasz.szarpak@gmail.com.
Lukasz
L
Szarpak
Anesthesiology and Intensive Care Unit, Mazovian Regional Hospital, Radom, Poland.
Katarzyna
K
Karczewska
Department of Emergency Medicine, UFuK University Medical faculty Dr. Ridvan Ege Education and Research Hospital, Ankara, Turkey.
Togay
T
Evrin
Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
Andrzej
A
Kurowski
Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland; Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland.
Lukasz
L
Czyzewski
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D002648:Child; D018592:Cross-Over Studies; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult