title: Comparison of Miller and Airtraq laryngoscopes for orotracheal intubation by physicians wearing CBRN protective equipment during infant resuscitation: a randomized crossover simulation study.
abstract: BACKGROUND
  The purpose of this study was to evaluate the performance of orotracheal intubation with the Miller laryngoscope compared with the Airtraq laryngoscope by emergency and pediatric physicians wearing CBRN-PPE type III on infant manikins with conventional airway. We hypothesized that in this situation, the orotracheal intubation with the Airtraq laryngoscope would be faster and more effective than with the Miller laryngoscope.
  
  
  METHODS
  This was a prospective, randomized, crossover, single-center study who recruited emergency department physicians on a voluntary basis. Each physician performed a total of 20 intubation trials while in CBRN-PPE with the two intubation techniques, Miller and Airtraq. Intubations by each airway device were tested over ten consecutive runs. The order of use of one or the other devices was randomized with a ratio of 1:1. The primary endpoint was overall orotracheal intubation success.
  
  
  RESULTS
  Fifty-five emergency and pediatric physicians were assessed for eligibility. Forty-one physicians were included in this study and 820 orotracheal intubation attempts were performed. The orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller (99% vs. 92%; p-adjusted <.001). The orotracheal intubation and glottis visualization times decreased with the number of attempts (p <.001). The median orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope (15 s vs. 20 s; p-adjusted <.001). The median glottis visualization time with the Airtraq laryngoscope and with the Miller laryngoscope were not different (6.0 s vs. 7.5 s; p-adjusted =.237). Thirty-four (83 %) physicians preferred the Airtraq laryngoscope versus 6 (15 %) for the Miller (p-adjusted <.001).
  
  
  CONCLUSIONS
  For tracheal intubation by physicians wearing CBRN-PPE during infant resuscitation simulation, we showed that the orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller laryngoscope and that orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope.
  
  
  CONCLUSIONS
  It seems useful to train the physicians in emergency departments in the use of pediatric Airtraq and for the management of CBRN risks.
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France. pierre.geraud.claret@gmail.com.|EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France. pierre.geraud.claret@gmail.com.
authors.forename: Pierre-Géraud
authors.initials: PG
authors.lastname: Claret
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Asencio
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Rogier
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Roger
authors.affiliation: Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Tu-Anh
authors.initials: TA
authors.lastname: Tran
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Emmanuel de La Coussaye
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D011481:Protective Clothing; D012151:Resuscitation
keywords: Accidents; Cardiopulmonary resuscitation; Cross-over studies; Infant; Intubation; Manikins; Protective devices