Tracheal Intubation
Conditions
Keywords
Advanced airway management, direct laryngoscopy, tracheal intubation, prehospital, videolaryngoscopy
Brief summary
Tracheal intubation using videolaryngoscopy may be required in the prehospital setting, where airway management presents unique technical and logistical challenges. Intubation may be hard because novice providers performing videolaryngoscopy may only look at the screen and only obtain a two-dimensional representation of the patient's airways. By directly visualizing the airways, these providers may obtain a better 3D apprehension and an improved mental visualization of the patient's anatomy. We aim to compare the impact of a freely realized videolaryngoscopy sequence with a sequence consisting in direct visualization of the airway followed by videolaryngoscopy (Direct Laryngoscopy-to-VideoLaryngoscopy sequence or DL-VL sequence) on time to intubation among novice providers.
Interventions
PROCEDUREDirect Laryngoscopy-to-VideoLaryngoscopy sequence
Participants will proceed with a double intubation technique sequence, first performing an initial direct laryngoscopy without looking at the video screen until they reached the epiglottis, then performing an indirect lryngoscopy for intubation.
PROCEDUREFree use of videolaryngoscopy
Participants are free to use of the videolaryngoscope as they intended
Sponsors
University Hospital, Geneva
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* All resident physicians with 1 to 6 years of post-graduate experience working in the Emergency Department (ED) at Geneva University Hospitals (Hôpitaux Universitaires de Genève (HUG)) and penultimate year of medical school students (5th year) studying at University of Geneva Faculty of Medicine (UGFM). * Performed less than 10 ETIs prior to participating in the study.
Exclusion criteria
* More than 6 years of post-graduate experience * Performed more than 10 ETIs prior to participating in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Intubation | Periprocedural | Time in seconds from blade insertion at the dental arch to adequate tracheal tube placement through the vocal cords, confirmed by the C-MAC video recording. A maximum of 60 seconds was allowed per ETI attempt. The maximum number of ETI attempts was limited to 3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Intubation for the first intubation attempt alone | Periprocedural | Time in seconds from blade insertion at the dental arch to adequate tracheal tube placement through the vocal cords, confirmed by the C-MAC video recording. A maximum of 60 seconds was allowed per ETI attempt. |
| First Pass Success rate | Periprocedural | Intubation first pass success rate, in percentage. |
| Number of intubations attempts | Periprocedural | An ETI attempt was defined as the insertion of the laryngoscope blade at the dental arch, regardless of whether tracheal tube placement was attempted. A maximum of 60 seconds was allowed per ETI attempt. The maximum number of ETI attempts was limited to 3. More than 3 attempts, it was considered as failed. |
| Time to Ventilation | Periprocedural | Time in seconds from blade insertion at the dental arch to successful ventilation confirmed by chest elevation. A maximum of 60 seconds was allowed per ETI attempt. |
| Subjective assessments | Periprocedural | Subjective assessments, including perceived difficulty (Question 1 - I found intubation easy. Question 2 - I felt comfortable intubating this way. Question 3 - I think the use of the VL was adequate to intubate OR I think the sequenced use of the VL helped me intubate. Question 4 - In a future similar clinical situation, I will make the same use of the VL to intubate OR I think doing a direct laryngoscopy before looking at the screen allows for faster intubation than doing an indirect laryngoscopy only. Question 5 - In a future similar clinical situation, I will make a different use of the VL to intubate OR In a future similar clinical situation, I will make the same use (DL-VL) of the VL to intubate. Question 6 - In a future similar clinical situation, I will make a different use (VL only) of the VL to intubate.), were appraised using a 5-point Likert scale ranging from Totally Agree to Totally Disagree. |
Countries
Switzerland
Outcome results
None listed