Department of Anaesthesia, Queen Elizabeth Hospital, King's Lynn, UK.
Acad Emerg Med. 2011 Jul;18(7):692-8. doi: 10.1111/j.1553-2712.2011.01115.x.
This study assesses intubation times and potential trauma with two new portable video laryngoscopes, the GlideScope Ranger (GSR) and the Venner A.P. Advance (APA), in a simulated difficult prehospital airway. The GSR has a hockey stick shape and is inserted by a different (midline) technique compared with direct laryngoscopy and requires the use of a stylet. The APA has a handle similar to a direct laryngoscope, but with an angulated difficult airway blade. The APA is designed to have an intuitive insertion technique somewhat similar to that of direct laryngoscopy (lateral tongue displacement) and has a guiding mechanism that foregoes the need for a stylet.
Thirty qualified paramedics received a short demonstration of each device and were asked to intubate a modified Grade III difficult laryngoscopy mannequin in a random order (closed envelope technique). Optimal view and tracheal intubation times were recorded, and potential trauma assessed by the number of additional discrete forward advances and by visual analog scale (VAS). Direct laryngoscopy was used as a comparator. The Wilcoxon rank sum test was used for intubation times, optimal view times, percentage of glottis opening (POGO) seen, and objective trauma assessment. Student's paired t-test was used for subjective trauma assessment and a Bonferroni correction was used for the primary outcome measures.
Participants declared a median of 60 (range 20 to 300) previous intubations. Time to achieve optimal view between APA and GSR was not different (20 seconds vs. 19 seconds; p = 0.19), but tracheal intubation was significantly faster with the APA (25 seconds vs. 46 seconds; p < 0.0001). Intubation success was ultimately 97% in both groups. Participants judged subjective trauma to be less for the APA than GSR on a VAS (1.6 cm vs. 3.3 cm; p < 0.001). More than three additional forward advances were required in 43% of GSR and 0% of APA intubations.
Following a brief demonstration to paramedics naïve to video laryngoscopy, the APA demonstrated earlier intubation, fewer additional discrete forward advances of the tube, and less participant-judged subjective trauma when compared to the GSR in this simulation model.
本研究通过模拟院前困难气道，评估两种新型便携式视频喉镜（GlideScope Ranger[GSR]和 Venner A.P. Advance[APA]）的插管时间和潜在创伤。GSR 呈曲棍球棒形状，与直接喉镜相比，采用不同的（中线）技术插入，需要使用管芯。APA 手柄类似于直接喉镜，但具有成角的困难气道叶片。APA 的设计具有类似于直接喉镜的直观插入技术（侧向舌移位），并具有引导机构，无需使用管芯。
30 名合格的护理人员接受了每种设备的简短演示，并按照随机顺序（封闭信封技术）要求他们对改良的 III 级困难喉镜模型进行插管。记录最佳视野和气管插管时间，并通过额外的离散前进步数和视觉模拟量表（VAS）评估潜在创伤。直接喉镜用作比较器。Wilcoxon 秩和检验用于插管时间、最佳视野时间、看到的声门张开百分比（POGO）和客观创伤评估。学生配对 t 检验用于主观创伤评估，并且对主要结果指标进行了 Bonferroni 校正。
参与者报告中位数为 60 次（范围 20 至 300 次）先前插管。APA 和 GSR 达到最佳视野的时间没有差异（20 秒与 19 秒；p = 0.19），但 APA 气管插管明显更快（25 秒与 46 秒；p < 0.0001）。两组最终插管成功率均为 97%。参与者在 VAS 上判断 APA 的主观创伤小于 GSR（1.6 厘米与 3.3 厘米；p < 0.001）。GSR 插管中有 43%需要额外进行超过 3 次的离散前进步，而 APA 中则不需要。
在对视频喉镜一无所知的护理人员进行简短演示后，在本模拟模型中，与 GSR 相比，APA 表现出更早的插管、更少的额外离散前进步数和参与者判断的较少主观创伤。
