Raimann Florian J, Tepperis Daniel M, Meininger Dirk, Zacharowski Kai, Schalk Richard, Byhahn Christian, Weber Christian F, Mutlak Haitham
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
Main-Kinzig-Clinic, Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Herzbachweg 14, 63571 Gelnhausen, Germany.
Emerg Med Int. 2019 Oct 1;2019:9690839. doi: 10.1155/2019/9690839. eCollection 2019.
Tracheal intubation still represents the "gold standard" in securing the airway of unconscious patients in the prehospital setting. Especially in cases of restricted access to the patient, video laryngoscopy became more and more relevant.
The aim of the study was to evaluate the performance and intubation success of four different video laryngoscopes, one optical laryngoscope, and a Macintosh blade while intubating from two different positions in a mannequin trial with difficult access to the patient.
A mannequin with a cervical collar was placed on the driver's seat. Intubation was performed with six different laryngoscopes either through the driver's window or from the backseat. Success, C/L score, time to best view (TTBV), time to intubation (TTI), and number of attempts were measured. All participants were asked to rate their favored device.
Forty-two physicians participated. 100% of all intubations performed from the backseat were successful. Intubation success through the driver's window was less successful. Only with the Airtraq® optical laryngoscope, 100% success was achieved. Best visualization (window C/L 2a; backseat C/L 2a) and shortest TTBV (window 4.7 s; backseat 4.1 s) were obtained when using the D-Blade video laryngoscope, but this was not associated with a higher success through the driver's window. Fastest TTI was achieved through the window (14.2 s) when using the C-MAC video laryngoscope and from the backseat (7.3 s) when using a Macintosh blade.
Video laryngoscopy revealed better results in visualization but was not associated with a higher success. Success depended on the approach and familiarity with the device. We believe that video laryngoscopy is suitable for securing airways in trapped accident victims. The decision for an optimal device is complicated and should be based upon experience and regular training with the device.
在院前环境中，气管插管仍是确保昏迷患者气道安全的“金标准”。特别是在接近患者受限的情况下，视频喉镜的应用越来越广泛。
本研究的目的是在模拟患者气道难以接近的人体模型试验中，评估四种不同视频喉镜、一种光学喉镜和一个麦金托什喉镜在从两个不同位置进行插管时的性能和插管成功率。
将佩戴颈托的人体模型放置在驾驶座上。使用六种不同的喉镜通过驾驶座车窗或从后座进行插管。测量成功率、C/L评分、获得最佳视野的时间（TTBV）、插管时间（TTI）和尝试次数。所有参与者被要求对他们喜欢的设备进行评分。
42名医生参与了研究。从后座进行的所有插管成功率均为100%。通过驾驶座车窗进行插管的成功率较低。只有使用Airtraq®光学喉镜时，成功率达到了100%。使用D型视频喉镜时获得了最佳视野（车窗C/L 2a；后座C/L 2a）和最短的TTBV（车窗4.7秒；后座4.1秒），但这与通过驾驶座车窗获得更高的成功率无关。使用C-MAC视频喉镜通过车窗插管时TTI最快（14.2秒），使用麦金托什喉镜从后座插管时TTI最快（7.3秒）。
视频喉镜在视野显示方面效果更好，但与更高的成功率无关。成功率取决于插管途径和对设备的熟悉程度。我们认为视频喉镜适用于确保被困事故受害者的气道安全。选择最佳设备的决策很复杂，应基于经验和对该设备的定期培训。
