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Endotracheal intubation with a video-assisted semi-rigid fiberoptic stylet by prehospital providers.

Cooney DR, Beaudette C, Clemency BM, Tanski C, Wojcik S - Int J Emerg Med (2014)

Bottom Line: The median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997).Demographic factors including handedness and eye dominance did not seem to affect outcomes.ALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.

ABSTRACT

Background: Emergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS).

Methods: ALS EMTs were first shown a brief slideshow and three example videos and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed on the floor to simulate field intubation at the scene. Each participant was given up to three timed attempts with each technique. Endotracheal tube position was confirmed with visualization by one of the study authors. Comparisons and statistical analysis were conducted using SPSS® Statistics 21 (IBM®). Demographics and survey results were also collected and analyzed.

Results: The median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997). Demographic factors including handedness and eye dominance did not seem to affect outcomes. Participants reported a relatively high level of satisfaction with the CVS.

Conclusions: ALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device. The CVS technique warrants further study for use as an alternative to DL and video laryngoscopy in the prehospital difficult airway scenario.

No MeSH data available.


Related in: MedlinePlus

ALS provider intubating the mannequin positioned on the floor.
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Fig2: ALS provider intubating the mannequin positioned on the floor.

Mentions: The video was 8 min and 22 s long and was followed by a hands-on period of familiarization lasting approximately 10 min during which participants were allowed to practice intubating the mannequin (Laerdal® Airway Management Trainer, Wappingers Falls, NY, USA) in a group with a standard 7.5-mm endotracheal tube (Rusch: Teleflex Medical, Research Triangle Park, NC, USA), using both the CVS and standard direct laryngoscopy (DL). During both the familiarization and testing phases, the mannequin was situated on the floor to simulate an out-of-hospital intubation scenario. Instruction on utilizing the CVS alone (without the use of a laryngoscope) was given describing a midline approach with the device. Alternative approaches to the use of the CVS were not utilized. Random selection (coin flip) was used to determine which technique would be used first by each participant. Each participant was given up to three attempts to intubate with each technique with the mannequin positioned on the floor (Figure 2). The attempts were timed from picking up the device, until the stylet (either the CVS or a standard malleable stylet) was removed from the endotracheal tube (ETT) in the mannequin. Location of the ETT after each attempt was confirmed utilizing the CVS to visualize the larynx after both techniques. When the participant was successful with either technique, they then utilized the other technique. If unsuccessful after three attempts with either device, the participant was instructed to move to the other technique. After completion of the intubation attempts, participants were asked to complete a demographics and survey form which included self-reported age, sex, eye dominance, handedness, and type of primary agency they work for. They rated their satisfaction with the CVS, perceived usefulness for their practice, and the effectiveness of the tutorial with 0 = not at all and 10 = completely.Figure 2


Endotracheal intubation with a video-assisted semi-rigid fiberoptic stylet by prehospital providers.

Cooney DR, Beaudette C, Clemency BM, Tanski C, Wojcik S - Int J Emerg Med (2014)

ALS provider intubating the mannequin positioned on the floor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4269860&req=5

Fig2: ALS provider intubating the mannequin positioned on the floor.
Mentions: The video was 8 min and 22 s long and was followed by a hands-on period of familiarization lasting approximately 10 min during which participants were allowed to practice intubating the mannequin (Laerdal® Airway Management Trainer, Wappingers Falls, NY, USA) in a group with a standard 7.5-mm endotracheal tube (Rusch: Teleflex Medical, Research Triangle Park, NC, USA), using both the CVS and standard direct laryngoscopy (DL). During both the familiarization and testing phases, the mannequin was situated on the floor to simulate an out-of-hospital intubation scenario. Instruction on utilizing the CVS alone (without the use of a laryngoscope) was given describing a midline approach with the device. Alternative approaches to the use of the CVS were not utilized. Random selection (coin flip) was used to determine which technique would be used first by each participant. Each participant was given up to three attempts to intubate with each technique with the mannequin positioned on the floor (Figure 2). The attempts were timed from picking up the device, until the stylet (either the CVS or a standard malleable stylet) was removed from the endotracheal tube (ETT) in the mannequin. Location of the ETT after each attempt was confirmed utilizing the CVS to visualize the larynx after both techniques. When the participant was successful with either technique, they then utilized the other technique. If unsuccessful after three attempts with either device, the participant was instructed to move to the other technique. After completion of the intubation attempts, participants were asked to complete a demographics and survey form which included self-reported age, sex, eye dominance, handedness, and type of primary agency they work for. They rated their satisfaction with the CVS, perceived usefulness for their practice, and the effectiveness of the tutorial with 0 = not at all and 10 = completely.Figure 2

Bottom Line: The median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997).Demographic factors including handedness and eye dominance did not seem to affect outcomes.ALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.

ABSTRACT

Background: Emergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS).

Methods: ALS EMTs were first shown a brief slideshow and three example videos and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed on the floor to simulate field intubation at the scene. Each participant was given up to three timed attempts with each technique. Endotracheal tube position was confirmed with visualization by one of the study authors. Comparisons and statistical analysis were conducted using SPSS® Statistics 21 (IBM®). Demographics and survey results were also collected and analyzed.

Results: The median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997). Demographic factors including handedness and eye dominance did not seem to affect outcomes. Participants reported a relatively high level of satisfaction with the CVS.

Conclusions: ALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device. The CVS technique warrants further study for use as an alternative to DL and video laryngoscopy in the prehospital difficult airway scenario.

No MeSH data available.


Related in: MedlinePlus