Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
PLoS One. 2020 Jul 30;15(7):e0236474. doi: 10.1371/journal.pone.0236474. eCollection 2020.
In pre-hospital emergency care, video laryngoscopes (VLs) with disposable blades are preferably used due to hygienic reasons. However, there is limited existing data on the use of VLs with disposable blades by emergency medical staff. Therefore, the aim of this study was to compare the efficacy of four different VLs with disposable blades and the conventional standard Macintosh laryngoscope, when used by anesthetists with extensive previous experience and paramedics with little previous experience in endotracheal intubation (ETI) in a simulated difficult airway.
Fifty-eight anesthetists and fifty-four paramedics participated in our randomized crossover manikin trial. Each performed ETI with the new Glidescope® Go™, the Dahlhausen VL, the King Vision™, the I-View™ and the Macintosh laryngoscope. "Time to intubate" was the primary endpoint. Secondary endpoints were "time to vocal cords", "time to ventilate", overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental compression and subjective impressions.
The Glidescope® Go™, the Dahlhausen VL and the King Vision™ provided superior intubation conditions in both groups without affecting the number of intubation attempts or the time required for successful intubation. When used by anesthetists with extensive experience in ETI, the use of VLs did not affect the overall success rate. In the hands of paramedics with little previous experience in ETI, the failure rate with the Macintosh laryngoscope (14.8%) decreased to 3.7% using the Glidescope® Go™ and the Dahlhausen VL. Despite the advantages of hyperangulated video laryngoscopes, the I-View™ performed worst.
VLs with hyperangulated blades facilitated ETI in both groups and decreased the failure rate by an absolute 11.1% when used by paramedics with little previous experience in ETI. Our results therefore suggest that hyperangulated VLs could be beneficial and might be the method of choice in comparable settings, especially for emergency medical staff with less experience in ETI.
在院前急救中，出于卫生原因，优先使用一次性刀片的视频喉镜（VL）。然而，关于有经验的急救医务人员使用一次性刀片 VL 的现有数据有限。因此，本研究的目的是比较四种不同的一次性刀片 VL 和传统的标准 Macintosh 喉镜，在有丰富经口气管插管（ETI）经验的麻醉师和 ETI 经验较少的急救人员在模拟困难气道中的效果。
58 名麻醉师和 54 名急救人员参加了我们的随机交叉模拟人体试验。每个人都使用新的 Glidescope® Go™、Dahlhausen VL、King Vision™、I-View™ 和 Macintosh 喉镜进行 ETI。“插管时间”是主要终点。次要终点是“声带时间”、“通气时间”、总成功率、插管尝试次数和优化操作、Cormack-Lehane 评分、牙齿压迫严重程度和主观印象。
Glidescope® Go™、Dahlhausen VL 和 King Vision™ 在两组中均提供了更好的插管条件，而不影响插管尝试次数或成功插管所需的时间。在有丰富 ETI 经验的麻醉师手中，VL 的使用并不影响总体成功率。在 ETI 经验较少的急救人员手中，Macintosh 喉镜的失败率（14.8%）使用 Glidescope® Go™和 Dahlhausen VL 降低至 3.7%。尽管具有超仰角的视频喉镜具有优势，但 I-View™ 的表现最差。
在两组中，具有超仰角刀片的 VL 均有助于 ETI，并使 ETI 经验较少的急救人员的失败率降低了 11.1%。因此，我们的结果表明，超仰角 VL 可能是有益的，在类似情况下可能是首选方法，尤其是对 ETI 经验较少的急救医务人员。
