Endotracheal Intubation With and Without Night Vision Goggles in a Helicopter and Emergency Room Setting: A Manikin Study.
BACKGROUND
Securing the airway by endotracheal intubation (ETI) is a key issue in prehospital critical care. Night vision goggles (NVG) are used by personnel operating in low-light environments. We examined the feasibility of an anesthesiologist performed ETI using NVG in a helicopter setting.


METHODS
Twelve anesthesiologists performed ETI on a manikin in an emergency room (ER) setting and two helicopter settings, with randomization to either rotary wing daylight (RW-D) or rotary wing in total darkness using binocular NVG (RW-NVG). Primary endpoint was intubation time. Secondary endpoints included success rate, Cormack-Lehane (CL) score, and subjective difficulty according to the Visual Analoge Scale (VAS).


RESULTS
The median intubation time was shorter for the RW-D compared to the RW-NVG setting (16.5 seconds vs. 30.0 seconds; p = 0,03). We found no difference in median intubation time for the ER and RW-D settings (16.8 seconds vs. 16.5 seconds; p = 0.91). For all scenarios, success rate was 100%. CL and VAS varied between the ER setting (CL 1.8, VAS 2.8), RW-D setting (CL 2.0, VAS 3.0), and RW-NVG setting (CL 3.0, VAS 6.5).


CONCLUSIONS
This study suggests that anesthesiologists successfully and quickly can perform ETI in a helicopter setting both in daylight and in darkness using binocular NVG, but with shorter intubation times in daylight.
Section of Anaesthesiology and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet/Södersjukhuset, Stockholm, Sweden.
Mikael
M
Gellerfors
Section of Anaesthesiology and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet/Södersjukhuset, Stockholm, Sweden.
Christer
C
Svensén
SAE Medevac Helicopter, Armed Forces Centre for Defense Medicine (FörmedC), Gothenburg, Sweden.
Joacim
J
Linde
Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.
Hans Morten
HM
Lossius
Section of Anaesthesiology and Intensive Care, Department of Physiology, Karolinska Institutet, Stockholm, Sweden.
Dan
D
Gryth
D000328:Adult; D017732:Air Ambulances; D000072080:Anesthesiologists; D018592:Cross-Over Studies; D003624:Darkness; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D006801:Humans; D007442:Intubation, Intratracheal; D008348:Manikins; D061212:Memory, Episodic; D008875:Middle Aged; D055254:Night Vision; D055096:Optical Devices; D013548:Sweden; D013997:Time Factors