title: Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial.
abstract: BACKGROUND
  The main cause of cardiac arrest in pediatric patients is respiratory failure.
  
  
  OBJECTIVE
  To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios.
  
  
  METHODS
  This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC.
  
  
  RESULTS
  A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P=.73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P=.67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC (P<.05) for all analyzed variables.
  
  
  CONCLUSIONS
  This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.
authors.affiliation: Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Szarpak
authors.affiliation: Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: zetrtrusz@gmail.com.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Truszewski
authors.affiliation: Department of Nephrologic Nursing, Medical University of Warsaw, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Czyzewski
authors.affiliation: Department of Anesthesiology and Intensive Care, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kurowski
authors.affiliation: Department of Anesthesiology and Intensive Care, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Bogdanski
authors.affiliation: Department of Anesthesiology and Intensive Care, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zasko
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods; D002648:Child; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D013997:Time Factors