Comparing the effectiveness between Air-Q intubating laryngeal airway and ambu® auragain™ laryngeal mask for controlled ventilation in paediatric patients : a randomized controlled trial

Background: Supraglottic airway device (SAD) is a common device use in anaesthesia practice including paediatric patients. Air-Q ILA (Cook gas LLC; Mercury Medical, Clearwater, FL, USA) is the newer first generation of SAD that can use for both primary airway device and an aid for tracheal intubation. Available literature demonstrated that this device performed better and equally to the other SAD including second generation of SAD. Ambu® AuraGain™ (Ambu, Ballerup, Denmark) is a newer second generation of SAD which incorporates both integrating gastric port access and intubation capability. The study is conducted to compare the effectiveness between Air- Q and Ambu AuraGain for controlled ventilation in children up to 30kg. Methods: 64 paediatric patients underwent various short surgical procedures were randomly assigned to receive either an Air-Q or Ambu AuraGain. Fibreoptic (FO) grades of laryngeal view were measured as the primary outcome. The secondary outcomes measured were oropharyngeal leak pressure (OLP), number of attempts, time of successful insertion, quality of airway during placement and maintenance of anaesthesia, haemodynamic parameters and complications. Results: Air-Q has more favourable FO grades of view compared to the Ambu AuraGain (P = 0.047). OLP is significantly higher in Air-Q group compared to Ambu AuraGain (19.41 ± 1.19 cm H20 vs 17.56 ± 1.52 cm H20, P value = <0.001). There were no differences in term of number of attempts, time of successful insertion, quality of airway during placement and maintenance of anaesthesia and complications

Randomized trial comparing the i-gel™ and Magill tracheal tube with the single-use ILMA™ and ILMA™ tracheal tube for fibreoptic-guided intubation in anaesthetized patients with a predicted difficult airway

Background The i-gel™ is a single-use supraglottic airway device (SAD) that allows fibreoptic-guided tracheal intubation through the device. Until now, no prospective data for this procedure are available. Therefore, in a prospective randomized controlled trial, we evaluated fibreoptic-guided tracheal intubation with a standard Rüsch™ PVC tracheal tube (TT) through the i-gel™ compared with the single-use ILMA™ (sILMA™) TT through the sILMA™ in patients with a predicted difficult airway. Methods With ethics committee approval and written informed consent, 160 patients were randomly assigned to either SAD. After placement of the SAD, a fibreoptic bronchoscope was introduced into the trachea as a railroad for the TT. Primary outcome variable was the first-attempt fibreoptic-guided intubation success rate. Secondary variables included time for insertion and intubation, airway leak pressures, fibreoptic view, and adverse events. Data are presented as mean (sd) or percentages. A P-value of <0.05 was considered statistically significant. Results Fibreoptic-guided intubation was successful at the first attempt in 76 patients (96%) using the i-gel™ and in 71 patients (90%) using the sILMA™ (P=0.21). Most of the failed intubations were rescued by conventional laryngoscopy. Airway leak pressure was higher for the sILMA™. There were no problems during removal of either type of SAD. Conclusions Fibreopic-guided tracheal intubation through the i-gel™ using a standard Rüsch™ Magill TT is successful and an alternative to the sILMA™ with the sILMA™ T

Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway

Background The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). Methods With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). Results Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. Conclusions Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel

The use of novel information technology in military medicine and mass casualty situation training

Tässä väitöskirjatyössä tutkitaan uuden mobiiliteknologian käyttöä sotilaslääketieteen ja suuronnettomuustilanteiden koulutuksessa. Yhteenvetona voidaan todeta, että uudesta informaatioteknologiasta on paljon hyötyä sekä pedagogisesti että teknisesti sotilaslääketieteellisessä koulutuksessa ja suuronnettomuustilanteiden lääkinnällisessä valmiudessa. Tutkimukseen valittiin seuraavat uudet informaatioteknologiat: lyhyet videoleikkeet (multimedia), mobiilit lääketieteen tietokannat ja RFID-teknologia (Radio frequency identification, radiotaajuinen etätunnistus). Sotilaslääketiede on osa kansallista terveydenhuollon järjestelmää, jossa tällaista tekniikkaa varten on eritystarpeita, kun kehitetään ensiavun ja ensihoidon opetusta kliinisesti vaativissa tilanteissa. Lääkintäaliupseerikurssin oppilaat (N=60) satunnaistettiin käyttämään joko kurkunpääputkea (LT), n=30 tai kurkunpäämaskia (ILMA), n=30. Kurkunpääputken (LT) sai onnistuneesti 10 kertaa peräkkäin paikoilleen 100 % ja kurkunpäämaskin (ILMA) 93,1 % oppilaista. Keskimäärin ensimmäinen onnistunut suoritus kesti hieman yli 20 sekuntia kummallakin menetelmällä, ja 10 suorituksen keskiarvo oli hieman yli 10 sekuntia. Kokemattomat ja kouluttamattomat lääkintäaliupseerikurssin oppilaat voivat oppia lyhyen videoleikkeen avulla varmistamaan hengitystiet kurkunpääputkella (LT) tai kurkunpäänaamarilla (ILMA) simuloidussa tilanteessa. VAS-asteikolla mitattu itsearviointi varmisti, että suoritus koettiin helpoksi. Mobiilia lääketieteen tietojärjestelmää ja sen käyttöä verrattiin lääketieteen opiskelijoiden ja varusmiespalvelustaan suorittavien lääkäreiden kesken. Tämä tutkimus on auttanut ymmärtämään sitä, miten nämä kaksi ryhmää käyttävät mobiilia lääketieteellistä tietojärjestelmää. Samalla se tarjoaa oivalluksia joihinkin pedagogisiin eroihin näiden kahden ryhmän välillä. Ryhmien väliset erot eivät kuitenkaan olleet tilastollisesti merkitseviä. Tutkimuksissa RFID-järjestelmä osoittautui toimivaksi. Verrattaessa järjestelmää tällä hetkellä käytettävään järjestelmään se paransi ratkaisevasti lääkinnällisen pelastustoiminnan valmiutta. Järjestelmä voidaan mukauttaa ilman vaikeuksia siviilialan suuronnettomuus- ja katastrofitilanteiden hallintaan. Testattu järjestelmä toteutettiin kaupallisesti saatavilla olevalla teknologialla (RFID ja matkapuhelinteknologia). Järjestelmän suoria hyötyjä ja sen toistettavuutta verrattiin suuronnettomuudessa käytettäviin paperisiin potilasluokittelukortteihin kahdessa erillisessä simuloidussa suuronnettomuustilanteessa Suomessa ja Ruotsissa. Molemmissa oli mukana monia viranomaistahoja. RFID-pohjainen järjestelmä, jossa potilaat luokiteltiin kiireellisyysluokkiin (triage) käyttämällä matkapuhelinjärjestelmää, lähetti välittömästi ja automaattisesti tilannetiedon harjoituksen johtoon ja sairaalaan. Molempien potilastietojärjestelmien avulla voitiin mitata tilannetietoisuuden kehittymistä suuronnettomuudessa siten, että verrattiin paperisista potilasluokittelukorteista saatua tietoa kännykän avulla saatuihin potilasluokittelutietoihin hoitoketjun eri vaiheissa. RFID-järjestelmä osoittautui helppokäyttöiseksi ja se paransi merkittävästi suuronnettomuuksien hallintaa ja tilannetietoisuutta. Koordinoivat yksiköt saivat RFID-järjestelmällä tietoja uhrien kiireellisyysluokista ja sijainnista yli tuntia aikaisemmin kuin perinteisellä menetelmällä. RFID-järjestelmä on helppokäyttöinen, nopea ja vakaa. Se osoittautui saumattomasti toimivaksi jopa ankarissa kenttäolosuhteissa. RFID-järjestelmä ylitti kaikilta osin perinteisen järjestelmän. Se tehosti merkitsevästi lääkinnällisen pelastustoiminnan organisatorista valmiutta.In developed countries, novel information technologies have become an essential part of education in modern healthcare field. However, using these expensive and continuously developing technologies is often a challenge both for trainers and for students. In military medicine, as a part of national healthcare services, there are special needs for this kind of technology, especially when optimizing first aid and initial treatment in challenging field situations. The purpose of this thesis was to study the use of novel information mobile technologies in the training for military medicine and mass casualty situations. Methods chosen were short video clips, mobile medical information system (IS) and radio frequency identification technology (RFID). Short video clips are potentially applicable as educational material in teaching advanced airway management and as the first means of introducing the use of a laryngeal tube (LT) or an intubating laryngeal mask (ILMA) to inexperienced military first-responder trainees with no prior hands-on experience. In a study, sixty medical non-commissioned officers were randomly assigned into one of two groups: the LT- and the ILMA-group. After viewing the video clips, the trainees were required to perform 10 consecutive, successful insertions of the given instrument into a manikin. The goal of 10 consecutive successful insertions was attained by all 30 subjects in the LT-group, and by 27 of 29 subjects in the ILMA-group with a maximum of 30 attempts. Satisfactory to good skill levels can be achieved with the applied video-clip demonstration method, even in inexperienced first-responder trainees lacking previous hands-on experience. Self-assessment measured by VAS score showed that the performance felt easy. A mobile medical information system (IS) was compared between civilian medical students and physicians undergoing compulsory military service in Finland. Special emphasis was placed on differences in system usage and perceptions towards the mobile medical IS. Other points of interest were the important features of the mobile medical system, advantages and disadvantages of using the system in actual emergency situations and use of the device to search for general information. A questionnaire was handed to both sixth-year medical students at the University of Oulu, as well to medical students of similar academic level undergoing their military service. The two groups were found to have similar approaches towards the mobile system in different contexts. The results have helped to develop an understanding of how the two groups of users use a mobile medical information system while also providing insight into some behavioral differences between them. Not all of the differences were significant; indicating the possibility of developing a universal tool for both military and with some civilian application, but with supplemental content in military medicine for military medical officers (MO). When reporting on the possibility of the development of a universal tool for both military and civilian use, MO`s said that they would have liked to complement the mobile medical information system with military medical data. The applicability of radio frequency identification (RFID) technology and commercial cellular networks designed to provide an online triage system for handling civilian mass casualty situations was tested during a military field exercise. The system proved to be usable. Compared to the current system in use, it dramatically improved the general view of mass casualty situations and enhances medical emergency readiness in this military medical setting. The system can be adapted without any difficulties by the civilian sector for the management of disasters. The feasibility and the direct benefits of the system were evaluated in two separate, simulated civilian mass-casualty situations; one in Finland involving a passenger ship accident and another at a major airport in Sweden with a plane crash scenario. Both simulations involved multiple authorities and functioned as a test setting for comparing the disaster management s situational awareness using the RFID -based system, where triage was done using both a mobile phone system with information sent automatically to the situation command center and the hospital, alongside a traditional method using paper triage tags. The development of situational awareness could be measured directly by comparing the availability of up-to date information at different points in the care chain with both systems. The RFID system proved easy to use, quick and stabile, and improved the situational awareness for the disaster management significantly. Information about the numbers and status of casualties was available for the coordinating units over an hour earlier in comparison to the traditional method. Results surpassed the traditional systems in all respects. It also dramatically improved the general view of mass casualty situations and enhanced medical emergency readiness in a multi-organizational medical setting. The novel information technologies addressed here are of great value both pedagogically and technically in medical training in military medicine and mass casualty situations

Comparison of LMA Fastrach and I-GEL as a conduit for Blind Tracheal Intubation

INTRODUCTION: The major responsibility of the anaesthesiologist is to provide adequate ventilation to the patient. The most vital element in providing functional respiration is the airway. Management of the airway has come a long way since the development of endotracheal intubation by Macewen in 1880 to present day use of modern and sophisticated airway devices. Using an endotracheal tube to secure a patient's airway is still the gold standard. Most routine orotracheal or nasotracheal intubations are performed with the help of a laryngoscope that has a curved or straight blade. Difficulties encountered during intubation can be due to a number of factors and may be difficult to predict. It is important to have a strategy prepared and to be familiar with the equipment. This will help to avoid potential morbidity or mortality from the sequelae of hypoxia and/or cardiovascular catastrophe that may result from a failed intubation. The anaesthesiologist must be familiar with the major decision making components of the difficult airway algorithm. Over the years many attempts have been made to address various factors responsible for difficult intubations and this has resulted in a number of different techniques. It is best to use affordable, safe and useful adjuncts that are best suited to our particular anaesthetic set up. Insertion of a supraglottic device in these situations is a recognised alternative and may be a life-saving procedure. Some supraglottic devices allow for subsequent tracheal intubation using a blind or a fibreoptic technique. Tracheal intubation through a classical laryngeal mask airway had been extensively studied and is more time consuming. One device commonly used as a conduit for intubation is the intubating laryngeal mask airway (ILMA). The ILMA has been the “gold standard” among the supraglottic airway devices since 1997. It has showed a high success rate for blind or fibreoptic-guided tracheal intubation in patients with both expected and unexpected difficult airways. I-GEL supraglottic airway (Intersurgical Ltd., Wokingham, UK) is a relatively new device for airway management. It is made from Styrene Ethylene Butadiene Styrene and is anatomically preformed to mirror the peri-laryngeal structures. It can be described as an uncuffed peri-laryngeal sealer according to Miller’s classification. We chose the I-GEL airway in comparison with the ILMA mainly because both devices allow direct tracheal intubation. I-GEL airway has some potential benefits over the ILMA: it is disposable, cheap and has an additional channel for drainage of gastric contents. Moreover, insertion of the I-GEL is usually easy and quick. Furthermore, its wide bore facilitates direct passage of a standard size tracheal tube. It can be a useful adjunct to tracheal intubation in patients with difficult airway as documented in several case reports. Data for the I-GEL airway as a conduit for blind endotracheal intubation is not available as only case reports have been published. Hence a prospective randomized single blind study was designed to compare the new supraglottic airway device, I-GEL, to ILMA as a conduit for blind endotracheal intubation in patients undergoing elective surgery under general anaesthesia. AIM OF THE STUDY: The aim of the study is to compare two supraglottic airway devices: I-GEL and Intubating LMA as a conduit for blind endotracheal intubation in patients undergoing elective surgery under general anaesthesia. We compare the two devices on the following metrics: 1. First attempt success rate for blind endotracheal intubation through the supraglottic airway device. 2. Total time required for the successful blind endotracheal intubation through the supraglottic airway device. 3. Ease of placement of supraglottic airway device a) Number of attempts required for the placement of the supraglottic airway device. b) Time required for the placement of the supraglottic airway device. MATERIALS AND METHODS: Study Design: This study was a single blind, randomized, prospective comparative study conducted in Government Stanley Medical College and Hospital, Chennai. Study Setting and Population: The Institutional Ethical committee approval was obtained before commencement of the study. Written informed consent was obtained from all the patients. Eighty adult patients of ASA Physical status 1 & 2 of either sex undergoing elective surgical procedures under general anaesthesia were enrolled in the study. The study was conducted at the General Surgery theatre complex, Stanley Medical College and Hospital, Chennai. The study was conducted from January 2010 to October 2010. The supraglottic airway device insertion and blind tracheal intubation was done by the author. PATIENT SELECTION: Inclusion criteria: 1. Age 20 to 50 years, 2. Both sexes, 3. Weight 40-70 kg., 4. Mallampatti 1 & 2, 5. ASA physical status 1-2, 6. Patients undergoing elective surgery under general anaesthesia, requiring endotracheal intubation. Exclusion Criteria: 1. Patients with limited mouth opening (less than 2 cm). 2. Anticipated difficult airway. 3. Patients at increased risk of aspiration, or having a history of symptomatic gastro-esophageal reflux or hiatus hernia. 4. Symptoms related to laryngo-pharyngeal anomaly. 5. Musculoskeletal abnormalities affecting the cervical vertebrae. MATERIALS: 1. Intubating Laryngeal mask airway (ILMA), 2. I-GEL, 3. Endo-tracheal tube, 4. IV cannulae, 5. Monitors, 6. Drugs for general anaesthesia. STUDY METHOD: After obtaining ethical committee approval, the patients were randomized into one of the two groups using a closed envelope method with predetermined group numbers and then single-blinded. 1. Group A: I-GEL for airway management, 2. Group B: ILMA for airway management. Patients were advised for preoperative overnight fasting for 8 hours. They were given aspiration prophylaxis with Tab Ranitidine 150 mg and Tab Metoclopramide 10 mg on the night before surgery and Inj. Glycopyrrolate 5mcg/kg im, one hour before induction. SUMMARY: Insertion of supraglottic airway and tracheal intubation through it may be indicated where conventional laryngoscopy fails. The ILMA was specially designed for this purpose. IGEL, a relatively new device has some benefits: disposable, cheap & its wide bore facilitate direct passage of a standard size tracheal tube. It can be a useful adjunct to tracheal intubation in patients with difficult airway as documented in several case reports. A prospective randomized single blind study was designed to compare the supraglottic airway devices I-GEL and ILMA as a conduit for blind endotracheal intubation in patients undergoing elective surgery under general anaesthesia. After obtaining the Institutional Ethical committee approval, eighty adult patients of ASA Physical status 1 & 2 of either sex undergoing elective surgical procedures under general anaesthesia wererandomly allocated into two groups, Group A: IGEL(n=40) and Group B: ILMA (n=40). Ease of tracheal intubation was assessed by the first attempt success rate, the total time required for the intubation. Ease of supraglottic device insertion was also assessed by the number of attempts and the time required for the device placement. Any complication during intubation was noted. The study showed no significant difference between the two groups based on the demographic variables. The mean insertion time for I-GEL was significantly less than ILMA (p<0.05). There was no statistical difference between the two groups in number of attempts required for the placement of the supraglottic airway device. The overall success rate, as well as the first attempt success rate for blind endotracheal intubation was high in the ILMA and were 95% and 87.5% respectively. The failure rate for blind endotracheal intubation through the supraglottic device was significantly high in the I-GEL (27.5%) with high incidence of esophageal intubation when compared to ILMA (p<0.05). The mean time for tracheal intubation was equal in both the groups. The time required for supraglottic device removal was significantly less for I-GEL (p<0.05). There was no statistically significant difference in the total time required for successful endotracheal intubation (including the time for airway insertion, tracheal intubation, device removal) between both the groups. Complications like oesophageal intubation and mucosal trauma were high with the IGEL. CONCLUSION: We conclude that, based on the results of our study, I-GEL aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. In contrary, ILMA being a gold standard device meant for intubation guide, has a high first attempt success rate for blind endotracheal intubation

What airway and vascular access skills can be performed whilst wearing the NHS issued chemical, biological, radiation, and nuclear personal protective equipment?

The introduction of chemical, biological, radiation and nuclear personal protective equipment (CBRN-PPE) across the National Health Service (NHS), in 2007, represented an increase in the capacity to treat patients following a CBRN incident. However, little was known on what impact the NHS CBRN-PPE would have on skill performance. To date a number of studies have evaluated various skills performed whilst wearing a range of CBRN-PPE, none of which resembles the NHS CBRN-PPE. This gap in the evidence prompted a series of research studies addressing the following research question, ‘What airway and vascular access skills can be performed whilst wearing the NHS issued chemical, biological, radiation, and nuclear personal protective equipment? The resulting nine published peer-reviewed papers are presented with a critical commentary in three chapters: Chapter 3 (Papers 1 to 4) assesses what clinical skills can be performed using the NHS CBRN-PPE; Chapter 4 (Papers 5 & 6) explores clinicians’ views on the preferences and experiences of airway management whilst wearing CBRN-PPE; and Chapter 5 (Papers 7 to 9) evaluates the optimal strategies of airway management whilst wearing the NHS CBRN-PPE. Chapter 6 is a summary of the findings presented in this thesis and presents a number of new research questions to further expand our knowledge-base, regarding skill performance whilst wearing NHS CBRN-PPE, reflecting the developmental nature of this area of research. The research contained in this thesis utilises a combination of randomised controlled trials, interviews and questionnaires, to ascertain the impact of the NHS CBRN-PPE on skill completion. Papers 1 to 4 recruited a group of mixed clinicians allowing subgroup analysis observing for inter-professional differences regarding skill performance. Whereas, Papers 7 to 9 recruited student paramedics ensuring similar levels of airway management skills, thereby isolating prior expertise as a variable. The research presented in this thesis has been used during simulation training as part preparations for the 2012 Olympics, in the development of a CBRN training DVD and incorporated into a textbook. The results have also been shared with NHS England working party on CBRN-PPE and, are being incorporated into CBRN treatment protocols by an overseas ambulance service

Masks and tubes used to support the neonatal airway – how to improve their fit, seal and correct placement

Despite the many changes in perinatal medicine in the last fifty years, infants still often and unpredictably need assistance with their breathing. Positive pressure delivered through a facemask remains the almost universal initial approach. This is then generally followed by endotracheal intubation if the infant is not responding or if prolonged support is needed. Despite many years of research into mask ventilation, it is still very challenging and leak and airway obstruction remain a problem. The thesis opens with two mask studies that try to solve this problem. The first is a manikin study that compared three different mask holds. It unfortunately found that there was no difference in the mask leak measured using the different holds. It is perhaps reasonable to change holds if the baby isn’t responding as expected. The second study aimed to measure the dimensions of preterm infants’ faces and compare these with the size of the most commonly available face masks. It found that the smallest size of some brands of mask is too large for many preterm infants. Masks of 35mm diameter are suitable for infants <29 weeks PMA or 1000g. Masks of 42 mm diameter are suitable for infants 27-33 weeks PMA or 750-2500g. The thesis then changed focus to neonatal intubation. Intubation is a challenging skill for paediatric trainees to master. In recent years success rates are decreasing. The next studies look at possible ways to change this trend. The first is a Cochrane review that examined if a stylet could improve intubation success. Only one unblended RCT has been performed and found no difference. The most sizable work of the thesis follows and is a RCT that examines if junior trainees intubation success rates are superior if they intubate with a videolaryngoscope. Two hundred and six intubations were randomised to the screen being visible to the supervisor or covered. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared to 41% (42/102) when the screen was covered, (p<0.001), OR 2.81 (95%CI 1.54-5.17). This shows that videolaryngoscopy is a promising tool to help inexperienced trainees become proficient intubators. This study has resulted in videolaryngoscopy becoming a tool commonly used in neonatal intensive cares. The next study looks at recordings of unsuccessful intubations from the RCT. If an attempt is unsuccessful, the intubator and instructor often cannot explain why making it difficult to know what to do differently in the future. The study found that lack of intubation success was most commonly due to failure to recognize midline anatomical structures. Excessive secretions are rarely a factor in elective premeditated and routine suctioning should be discouraged. Better videolaryngoscope blade design may make it easier to direct the tube through the vocal cords. The final work of the thesis is a review that examines devices used during newborn stabilization. Evidence for their use to optimize the thermal, respiratory and cardiovascular management in the delivery room is presented. After completing all this work I think that perhaps it is time to lessen our reliance on facemasks and embrace other airway devices that are showing promise, particularly the laryngeal mask. I feel that universal intubation competency is no longer feasible but universal competency on the use of laryngeal masks probably is. This urgently needs to be addressed in paediatric training programs. Videolaryngoscopy is a promising tool that improves junior intubators’ success rates. To master intubation many intubations are still necessary but the videolaryngoscope allows the slope of the learning curve to steepen. Development is necessary to design scopes of the future that are inexpensive, easily portable and user friendly

Role of video laryngoscopy in the management of difficult intubations in the emergency department and during prehospital care

AbstractAlthough the advent of emergency medicine as a specialty has led to advances in emergency airway management, airway management is still challenging for emergency physicians. Moreover, patients in need of intubation frequently present in the emergency department (ED) with medical or traumatic conditions that greatly increase the difficulty of managing the airway. In most cases, a direct laryngoscope is used for intubation, and a series of maneuvers are required to directly visualize the vocal cords and place a flexible plastic tube into the trachea. Difficult intubations usually occur with an inadequate glottic view. Operating room studies have shown that video and optical laryngoscopy, in which a miniature video camera enables the operator to visualize the glottis indirectly, improves glottic exposure and the ease of intubation compared with direct laryngoscopy. Video laryngoscopy is becoming more accessible to emergency physicians, yet whether these performance characteristics translate to emergency patients remains unclear. The aim of our article is to provide an up-to-date literature review of video laryngoscopy. We especially focus on learning with mannequins, and clinical performance in normal and difficult airways in the ED and prehospital settings