Intubation using VieScope vs. Video laryngoscopy in full personal protective equipment - a randomized, controlled simulation trial

Background: VieScope is a new type of laryngoscope, with a straight, transparent and illuminated blade, allowing for direct line of sight towards the larynx. In addition,VieScope is disposed of after single patient use, which can avoid cross-contaminations of contagious material. This has gained importance especially when treating patients with highly contagious infectious diseases, such as during the SARS-CoV2 pandemic. In this context, VieScope has not been evaluated yet in a clinical study. Material and methods: This study compared intubation with VieScope to video-laryngoscopy (GlideScope) in normal and difficult airway in a standardized airway manikin in a randomized controlled simulation trial. Thirty-five medical specialists were asked to perform endotracheal intubation in full personal protective equipment (PPE). Primary endpoint was correct tube position. First-pass rate (i.e., success rate at the first attempt), time until intubation and time until first correct ventilation were registered as secondary endpoints. Results: For correct tracheal tube placement, there was no significant difference between VieScope and GlideScope in normal and difficult airway conditions. VieScope had over 91% fist-pass success rate in normal airway setting. VieScope had a comparable success rate to GlideScope in difficult airway, but had a significantly longer time until intubation and time until ventilation. Conclusion: VieScope and GlideScope had high success rates in normal as well as in difficult airway. There was no unrecognized esophageal intubation in either group. Overall time for intubation was longer in the VieScope group, though in an acceptable range given in literature. Results from this simulation study suggest that VieScope may be an acceptable alternative for tracheal intubation in full PPE

Implementation of Antibiotic Stewardship Improves the Quality of Blood Culture Diagnostics at an Intensive Care Unit of a University Hospital

Background: Bloodstream infections increase morbidity and mortality in hospitalized patients and pose a significant burden for health care systems worldwide. Optimal blood culture diagnostics are essential for early detection and specific treatment. After assessing the quality parameters at a surgical intensive care unit for six months, we implemented a diagnostic stewardship bundle (DSB) to optimize blood culture diagnostics and then reevaluated its effects after six months. Material and Methods: All patients >= 18 years old and on the ward were included: pre-DSB 137 and post-DSB 158. The standard quality parameters were defined as the number of blood culture sets per diagnostic episode (>= 2), the rate of contamination (2-3%), the rate of positivity (5-15%), the collection site (>= 1 venipuncture per episode) and the filling volume of the bottles (8-10 mL, only post-DSB). The DSB included an informational video, a standard operating procedure, and ready-to-use paper crates with three culture sets. Results: From pre- to post-interventional, the number of >= 2 culture sets per episode increased from 63.9% (257/402) to 81.3% (230/283), and venipunctures increased from 42.5% (171/402) to 77.4% (219/283). The positivity rate decreased from 15.1% (108/714) to 12.8% (83/650), as did the contamination rate (3.8% to 3.6%). The majority of the aerobic bottles were filled within the target range (255/471, 54.1%), but in 96.6%, the anaerobic bottles were overfilled (451/467). Conclusions: The implementation of DSB improved the quality parameters at the unit, thus optimizing the blood culture diagnostics. Further measures seem necessary to decrease the contamination rate and optimize bottle filling significantly

Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario - a randomized, controlled simulation trial

Background Endotracheal intubation continues to be the gold standard for securing the airway in emergency situations. Difficult intubation is still a dreadful situation when securing the airway. Objective To compare VieScope with Glidescope and conventional Macintosh laryngoscopy (MAC) in a simulated difficult airway situation. Methods In this randomized controlled simulation trial, 35 anesthesiologists performed endotracheal intubation using VieScope, GlideScope and MAC in a randomized order on a certified airway manikin with difficult airway. Results For the primary endpoint of correct tube position, no statistical difference was found (p = 0.137). Time until intubation for GlideScope (27.5 +/- 20.3 s) and MAC (20.8 +/- 8.1 s) were shorter compared to the VieScope (36.3 +/- 10.1 s). Time to first ventilation, GlideScope (39.3 +/- 21.6 s) and MAC (31.9 +/- 9.5 s) were also shorter compared to the VieScope (46.5 +/- 12.4 s). There was no difference shown between handling time for VieScope (20.7 +/- 7.0 s) and time until intubation with GlideScope or MAC. Participants stated a better Cormack & Lehane Score with VieScope, compared to direct laryngoscopy. Conclusion Rate of correct tracheal tube position was comparable between the three devices. Time to intubation and ventilation were shorter with MAC and Glidescope compared to VieScope. It did however show a comparable handling time to video laryngoscopy and MAC. It also did show a better visualization of the airway in the Cormack & Lehane Score compared to MAC

Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations

Context Currently, approximately 100 000 helicopter emergency medical service (HEMS) missions for patients are undertaken in Germany each year. Compared to the early years, risk has reduced significantly, but is still higher than commercial aviation or other airborne operations. Objective The aim of the present study was to evaluate helicopter accidents and fatalities related to HEMS operations. Design Retrospective study of HEMS accidents in Germany. Setting Analysis of accidents in the published flight accident reports of the German Federal Agency for Flight Accident Investigation (40-year period from 1970 to 2009). Data were collected by telephone interview with the operators, manual search of publications and by supplemental internet information. Main outcome measures Data were analysed per 10 000 missions. For statistical analysis, Fisher's exact test was used. A P value less than 0.05 was considered significant. Results During the period analysed, a total of 1.698 million HEMS missions (1970 vs. 2009: 61 vs. 98 471) were flown by a mean of 50 +/- 27 (1 vs. 81) helicopters. To date, missions resulted in a total of 99 accidents with a mean of 2.4 +/- 1.7 accidents per year (range 0-7). The accident rate was 0.57 (0-11.4) per 10 000 missions and the fatal accident rate was 0.11 (0-0.5). Some 64% of missions did not result in any injuries to occupants, whereas 19.2% were fatal. From the accidents analysed, 43.4% were due to collision with an obstacle during landing, take-off or hovering. Landing was the phase of flight most often associated with accidents (44.4%). Conclusion The present study is the largest on HEMS accidents and the only one analysing an entire 40-year time course beginning with inception. In comparison to previous data, a significantly lower accident rate per 10 000 missions was found. Gathering data on the early years is nearly impossible, and further analysis is required to calculate the risk of fatality or identify injury patterns. Eur J Anaesthesiol 2011;28:766-77

Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

Background If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions. Methods A CPR-training manikin recording CPR-quality was placed on the fifth floor and was evacuated to an ambulance via lift, turntable ladder, or staircase. Chest compressions were performed manually or with a mechanical CPR-device. Efficiency endpoints were compression depth and frequency, sufficiency of chest release, compared with European Resuscitation Council (ERC) Guidelines, and duration of the evacuation. Adverse outcomes were disconnection/dislocation of devices and hazards/accidents to the personnel. Results For all evacuation routes, compression depth and frequency were significantly more compliant with ERC-guidelines under mechanical CPR. Manual CPR was associated with considerable deviations from correct compression depth and frequency. Chest release only slightly differed between groups. Evacuation via lift under mechanical CPR was fastest and evacuation via turntable ladder under manual CPR was slowest. No device disconnections or accidents occurred, but hazard to personnel was perceived during evacuation via ladder under manual CPR. Conclusions In this study, a mechanical CPR-device proved to deliver better CPR-quality during evacuation from an upper floor. If a lift accessible with a stretcher is available, this route should be preferred, regardless of manual or mechanical CPR. Turntable ladders can only be meaningfully used with mechanical CPR, otherwise CPR-quality is poor and hazard to the personnel is increased. Not all evacuation routes may be useable in a specific real-life scenario