比较急救人员在穿戴个人防护装备时使用 Vie Scope® 和 Macintosh 喉镜进行插管的效果。
Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment.
机构信息
Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland; Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
出版信息
Am J Emerg Med. 2022 Mar;53:122-126. doi: 10.1016/j.ajem.2021.12.069. Epub 2022 Jan 4.
BACKGROUND
Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE).
METHODS
Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers.
RESULTS
We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001).
CONCLUSIONS
The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures.
TRIAL REGISTRATION
ClinicalTrials registration number NCT04365608.
背景
气管插管（ETI）仍然是气道管理的金标准，但在疑似 SARS-CoV-2 感染患者发生心搏骤停的情况下，ETI 会给患者和医务人员带来风险。我们假设在操作人员佩戴个人防护装备（PPE）时，Vie Scope® 比常规的 Macintosh 叶片喉镜更有助于对疑似或确诊 COVID-19 心搏骤停患者进行气管插管。
方法
该研究设计为一项由波兰急救医疗服务机构进行的前瞻性、多中心、随机临床试验。纳入需要在院前环境中进行心肺复苏的疑似或确诊 COVID-19 诊断的患者。年龄在 18 岁以下或直接喉镜下预测插管困难的患者被排除在外。患者被随机分配 1:1 接受 Vie Scope® 与 Macintosh 叶片喉镜。比较两组插管尝试的成功率、插管时间、声门可视化和优化操作次数。
结果
我们共纳入 90 例院外心脏骤停（OHCA）患者，年龄 43-92 岁。与 VieScope® 喉镜相比，使用 Macintosh 喉镜进行气管插管需要更长的时间，估计平均差值为-48 秒（95%CI 置信区间 [CI]，-60.23，-35.77；p<0.001）。此外，VieScope® 提高了首次尝试的成功率，分别为 93.3%和 51.1%（优势比 [OR] = 13.39；95%CI：3.62，49.58；p<0.001）。
结论
在急救人员佩戴 PPE 进行气溶胶产生操作时，与 Macintosh 喉镜相比，Vie Scope® 喉镜在 OHCA 患者中可提高首次尝试成功率，并缩短插管时间。
试验注册
ClinicalTrials 注册号 NCT04365608。
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