Yousif Sami, Machan Jason T, Alaska Yasser, Suner Selim
1Emergency Medicine Department,King Saud bin Abdulaziz University for Health Sciences,Riyadh,Saudi Arabia.
3Lifespan Hospital System,Providence,Rhode IslandUSA.
Prehosp Disaster Med. 2017 Aug;32(4):352-356. doi: 10.1017/S1049023X17000188. Epub 2017 Mar 20.
Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.
In this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device.
A total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons).
Use of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use. Yousif S , Machan JT , Alaska Y , Suner S . Airway management in disaster response: a manikin study comparing direct and video laryngoscopy for endotracheal intubation by prehospital providers in Level C personal protective equipment. Prehosp Disaster Med. 2017;32(4):352-356.
引言 气道管理是医疗人员在灾难应对行动中面临的众多挑战之一。特别是，发现使用个人防护装备（PPE）与更高的失败率以及更长的气道控制时间相关。假设/问题 本研究的目的是确定视频喉镜是否能促进穿着C级个人防护装备的灾难救援人员进行气管插管操作。
在这项前瞻性、随机、交叉研究中，招募了一组方便样本的院前急救人员。在进行个人防护装备使用的标准化培训和气道设备使用的特定培训后，观察穿着C级个人防护装备的受试者在Laerdal复苏安妮人体模型系统（挪威斯塔万格的Laerdal Medical公司）上使用以下三种喉镜设备之一对模拟气道进行气管插管的情况，设备使用顺序随机：麦金托什直接喉镜（美国纽约的Welch Allyn公司）、GlideScope Ranger视频喉镜（美国华盛顿州博塞尔的Verathon Medical公司）和King Vision视频喉镜（美国印第安纳州诺布尔斯维尔的King Systems公司）。主要结局是插管时间（TTI），次要结局是受试者对每种设备易用性的感受。
共有20名院前急救人员参与了该研究：18名（90%）护理人员和2名（10%）心脏急救医疗技术员。与使用麦金托什喉镜[25.69秒（95%CI，22.42 - 29.42）；校正后P <.0001]或King Vision喉镜[29.87秒（95%CI，26.08 - 34.21）；校正后P =.033]相比，受试者使用GlideScope Ranger喉镜成功插管的时间显著更长[35.82秒（95%CI，32.24 - 39.80）]，而麦金托什喉镜和King Vision喉镜之间无显著差异（校正后P =.1017）。在0%至100%视觉模拟量表（VAS）上评估的自我报告满意度测量结果显示，在进行多重性校正之前，受试者对King Vision喉镜的满意度[86.7%（标准差 = 76.4 - 92.9%）]略高于GlideScope Ranger喉镜[73.0%（标准差 = 61.9 - 81.8%）；P =.04]和麦金托什喉镜[69.9%（标准差 = 57.9 - 79.7%）；P =.05]。GlideScope Ranger喉镜和麦金托什喉镜本身无差异（P =.65），在进行多重性校正后差异无统计学意义（两种比较的校正后P均为.12）。
对于穿着C级个人防护装备的院前急救人员，使用视频喉镜进行气管插管并不比使用麦金托什喉镜更快。特别是，King Vision视频喉镜的表现至少与麦金托什喉镜一样好，并且据报告更易于使用。尤西夫·S、马钱·J·T、阿拉斯加·Y、苏纳·S。灾难应对中的气道管理：一项人体模型研究，比较直接喉镜和视频喉镜在穿着C级个人防护装备的院前急救人员进行气管插管中的应用。《院前灾难医学》。2017年；32(4):352 - 356。
