Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy Laryngoscopes.
BACKGROUND
Tracheal intubation during cardiopulmonary resuscitation is a high-risk procedure. The aim of this study was to compare efficacy of intubation with the Pentax AWS, Airtraq, and McCoy laryngoscopes in patients with cervical spine immobilization during resuscitation in a randomized, controlled simulation trial.


METHODS
We compared times to intubation, success rate, Cormack and Lehane grading, and ease of intubation when using Pentax AWS, Airtraq, and McCoy in randomized order.


RESULTS
Sixty-seven paramedics were trained in the use of the Pentax AWS, Airtraq, and McCoy laryngoscopes with a METIman Prehospital manikin. Participants performed tracheal intubation in patients with cervical spine immobilization during resuscitation scenario. We measured success rates, times for tracheal intubation, the glottic view, and ease of intubation.


RESULTS
The primary study end point, overall success rate, was highest when using Pentax AWS (94.0%) and was lower in Airtraq (86.6%; P = .017) and in McCoy (85.1%; P = .019). Time to first effective ventilation was achieved significantly shorter when using Pentax AWS (25.4 ± 6.7 seconds) than Airtraq (35.6 ± 5.1 seconds; P < .001) or McCoy (38.5 ± 10.3 seconds; P < .001). The quality of glottic view and ease of use were best with Pentax AWS.


CONCLUSIONS
The Pentax AWS videolaryngoscope provided a better view of the vocal cords, less insertion time, and higher success rate of the endotracheal intubation compared with the Airtraq or McCoy laryngoscopes in adults with simulated cervical spine immobilization during resuscitation.
Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
Łukasz
Ł
Bogdański
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: zetrtrusz@gmail.com.
Zenon
Z
Truszewski
Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
Andrzej
A
Kurowski
Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland.
Łukasz
Ł
Czyżewski
Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland.
Piotr
P
Zaśko
Student Research Circle at the Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Adamczyk
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
Łukasz
Ł
Szarpak
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002574:Cervical Vertebrae; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D012149:Restraint, Physical; D000066908:Simulation Training