Novel airway device Vie Scope in several pediatric airway scenario: A randomized simulation pilot trial

CONTEXT: Endotracheal intubation of pediatric patients is challenging, especially in the pre-hospital emergency setting and if performed by less experienced providers. Securing an airway should be achieved with a single intubation attempt, as each intubation attempt contributes to morbidity and mortality. A new airway device, the VieScope, was recently introduced into clinical market, but efficacy to reduced intubation attempts remains unclear thus far. OBJECTIVE: We aimed to compare endotracheal intubation by paramedics using the Vie Scope in different pediatric airway simulation conditions. METHODS: We conducted a randomized, cross-over simulation study. Following a theoretical and practical training session, paramedics performed endotracheal intubation in 3 different pediatric emergency scenarios: normal airway; tongue edema; cardiopulmonary resuscitation using the VieScope. Overall intubation success rate was the primary outcome. Secondary outcomes included number of intubation attempts, time to intubation, Cormack-Lehane grade, POGO score, and ease of use (using 1-100 scale). RESULTS: Fifty-five paramedics with at least 2 years of clinical experience and without any previous experience with the VieScope participated in this study. The overall intubation success rate was 100% in all 3 scenarios. The median intubation time was 27 (24-34) versus 27 (25-37) versus 29 (25-40) s for scenarios A, B, and C, respectively. In scenario A, all paramedics performed successful intubation with 1 single intubation attempt, whereas 2% of the paramedics had to perform 2 intubation attempts in scenario B and 9% in scenario C. CONCLUSIONS: Results of this simulation study indicate preliminary evidence, that the VieScope enables adequate endotracheal intubation in the pediatric setting. Further clinical studies are needed to confirm these results

VieScope® laryngoscope versus Macintosh laryngoscope during difficult intubation performed by paramedics: a randomized cross-over manikin trial

INTRODUCTION: The aim of this study was to evaluate intubation performance by paramedics using Macintoshlaryngoscope and VieScope® laryngoscope under simulated difficult airway conditions. METHODS: In a randomized, single-blinded, cross-over simulation trial, 42 paramedics performed endotrachealintubation using VieScope® and Macintosh (MAC) laryngoscopes in two difficult airway scenarios: (A)tongue edema, (B) manual cervical inline stabilization. The order of participants and intubation methods wasrandom. Time to ventilation constituted the primary outcome, and the secondary outcomes were the successrate of first intubation attempt, overall intubation success rate, Cormack and Lehane grade, and ease of use. RESULTS: In scenario A, the median overall intubation time was 55s (46–109) in the MAC group and 30.5s(26–35) in the VieScope® group (p < 0.001). The efficacy of the first intubation attempt with MAC and Vie-Scope® varied and amounted to 64.3% vs. 95.2% (p < 0.001). During scenario B, VieScope® offered betterintubation conditions than MAC (p < 0.001), including shorter intubation time, higher first attempt andoverall intubation success rates, as well as better glottic view. CONCLUSIONS: In this simulation trial, we found that VieScope® could be successfully used for intubation indifficult airways by paramedics with little simulation experience with this device. VieScope® was associatedwith shorter time and higher success rates of intubation attempt compared with MAC. Nevertheless, werecommend that the performance of VieScope® and MAC should be further evaluated in the clinical settingto confirm our results

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Background: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especiallyin the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing fullpersonal protective equipment. This study aims were to assess the characteristics and outcomes of adultswho suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams.Methods: All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed.The retrospective EMS database was conducted. EMS interventions performed between March 1,and April 30, 2020 were retrospectively screened.Results: In the study period EMS operated 527 times for OHCA cases. The average age of patientswith OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%).298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitatedpatients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% ofpatients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonaryresuscitation was ineffective and death was determined.Conclusions: The present study found that OHCA incidence rate in the Masovian population (centralregion of Poland) in March–April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneouscirculation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockablerhythms was associated with better prognosis. The prehospital mortality, even though it was high, didnot differ from those reported by other studies

Airtraq® versus Macintosh laryngoscope for airway management during general anesthesia: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION: Despite the introduction of supraglottic devices for ventilation, endotracheal intubation is still a gold standard for airway management in both prehospital and operating theatre conditions. This systematic review and meta-analysis were conducted to investigate the effectiveness and safety of Airtraq vs. Macintosh laryngoscope for endotracheal intubation during general anesthesia. MATERIAL AND METHODS: The current issue of Pubmed, Embase, Cochrane, Web of science, Scopus (from database inception to October 20, 2020) was searched. Randomized controlled trials (RCT) comparing Airtraq and Macintosh laryngoscope were included in this meta-analysis. The primary outcomes were the success rate of first attempt intubation and intubation time. Secondary outcomes were overall intubation success rate, malposition, and adverse events. Review Manager 5.4 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. RESULTS: Seventeen studies were included in the review for data extraction. First attempt success rate was 85.6% for ATQ vs. 68.4% for MAC (OR = 3.00; 95% CI: 1.37, 6.60; p = 0.006; I2 = 63%). The use of ATQ and MAC for intubation in cervical spine immobilization was associated with the effectiveness of the first intubation attempt at 98.6% vs. 71.1% (OR = 16.40; 95% CI: 3.55, 78.87; p < 0.001; I2 = 0%). Intubation time with ATQ was shorter than with MAC (MD = -3.19; 95% CI: -9.33, 2.95; p = 0.31; I2 = 97%). The endotracheal intubation during cervical spinal intubation was associated with significantly shorter procedurę duration for ATQ than for MAC (MD = -10.30; 95% CI: -18.43, -2.18; p = 0.01; I2 = 74%). The total efficacy of intubation, which for ATQ and MAC varied and was 86.7% vs. 80.6% respectively (OR = 2.88; 95% CI: 1.61, 5.13; p < 0.001; I2 = 0%). CONCLUSIONS: Based on the results of this analysis, we conclude that ATQ can reduce the failed first intubation attempt, especially in cervical manual inline stabilization patients, and reduces the time needed to obtain airway management, but does not provide significant benefits on other adverse events associated with tracheal intubation. Further studies are needed to demonstrate whether severe adverse events are significantly different between the two devices

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios