Department of Anesthesiology, University of Cincinnati Medical Center, 231 Albert Sabin Way, P.O. Box 670531, Cincinnati, OH 45267-0351 USA.
University of Cincinnati Medical Center, C-STARS Program, 234 Goodman Street, Cincinnati, OH 45202 USA.
Mil Med Res. 2017 Jun 14;4:20. doi: 10.1186/s40779-017-0129-2. eCollection 2017.
The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission.
A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed.
Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp.
Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists.
接受军事医疗后送的危重症或受伤患者可能需要紧急插管。插管可能是救命的，但它也有风险。新手或不常进行喉镜检查的医生处于明显劣势，因为经验对于快速、安全建立安全气道至关重要。在飞机后部的恶劣环境下，这一挑战更加复杂，且处于停电状态。本研究通过在标准军用运输支柱和地板上使用简易装置，在三种情况下（正常气道灯光、困难气道灯光和困难气道停电）比较新手和专家喉镜检查者使用五种不同视频辅助插管设备（VAID）进行插管的成功率，来确定哪一种最适合美国空军重症监护空中运输队在飞行中使用，同时尽量减少设置时间和额外的光发射。
方便选择了 40 名参与者（24 名新手和 16 名专家），使用 5 种不同的视频喉镜设备对高保真气道模拟人进行插管。记录气管插管时间和使用的优化操作次数。Kruskal-Wallis 检验确定了在每种特定情况下，VAID 之间插管时间的显著差异。对具有显著差异的设备进行两两比较测试，使用秩和分析进一步澄清差异。记录设备组装时间、启动时间和发射的光量。对易用性进行了调查。
新手在所有困难气道情况下都使用 Pentax AWS 最快。专家使用 5 种设备中的 3 种始终记录最短的中位数时间。在测试的 6 种情况中，AWS 在 4 种情况下具有优势。专家和新手主观上认为 GlideScope Ranger 最容易使用。所有设备发射的光量均低于美国空军发布的头灯。
在所有困难气道情况下，新手使用 Pentax AWS 插管最快。GlideScope 需要最短的设置时间，参与者认为该设备最容易使用。GlideScope 和 AWS 显示了两个最快的总设置时间。这两种设备都适合不常进行喉镜检查的新手和经验丰富的医生在飞行中使用。
