Tracheal Intubation
Conditions
Keywords
advanced airway management, laryngoscopy, sitting position, prehospital, manikin, randomized controlled trial
Brief summary
Endotracheal intubation may be needed in critically ill patients in the prehospital setting, where difficult conditions may be encountered. The patient may be lying on the ground, thus complicating direct laryngoscopy as the operator's visual axis cannot be properly aligned with the patient's oral-pharyngeal-tracheal axis. The posture sitting cross-legged (Lotus position) at the head of the patient may allow an easier alignment of the visual axes due to a lower operator's head position and more stability. We compared the impact of the Lotus position with free positioning of the operator for direct laryngoscopy on intubation first pass success rate among novice operators.
Interventions
PROCEDUREFree positioning
Participants are not given instructions on how to position for intubation using direct laryngoscopy.
PROCEDURESitting cross-legged (Lotus position)
Participants are requested to sit cross-legged for intubation using direct laryngoscopy.
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 doctors 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 take part in the research
Exclusion criteria
* More than 6 years of post-graduate experience * Performed more than 10 ETIs prior to take part in the research
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First Pass Success rate | Periprocedural | In percentage, defined as achieving successful ETI on the initial attempt. An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt. |
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 ventilation, ruling out first-attempt failures. A maximum of 60 seconds was allowed per ETI attempt. |
| Number of intubations attempts | Periprocedural | An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt. |
| Time to Intubation | Periprocedural | Time in seconds from blade insertion at the dental arch to successful ventilation. A maximum of 60 seconds was allowed per ETI attempt. |
| Percentage Of Glottis Opening (POGO) score | Periprocedural | For each attempt, the percentage of glottis opening was assessed by the participant, using the POGO score. |
| Subjective assessments | Periprocedural | Perceived difficulty was appraised using a 5-point Likert scale ranging from Totally Agree to Totally Disagree. |
| Cormack and Lehane (CL) score | Periprocedural | For each attempt, the view of the larynx was assessed by the participant using the Cormack-Lehane score. |
Countries
Switzerland
Outcome results
None listed