Endotracheal Intubation
Conditions
Keywords
Augmented Reality, Video Laryngoscopy, Endotracheal Intubation, Prehospital Emergency Care, Moving Ambulance, Smart Glasses, Airway Management, Simulation
Brief summary
This randomized crossover simulation study evaluated the performance of augmented reality (AR) smart glasses compared with conventional video laryngoscopy (VL) for endotracheal intubation under simulated prehospital ambulance conditions. Prehospital emergency care professionals performed endotracheal intubation using both AR and VL in a stationary ambulance and in a moving ambulance. The moving ambulance scenario was conducted on a standardized 1-km training track at a constant speed of 20 km/h and included four speed bumps and four 90-degree turns. Each participant completed all four study conditions in a randomized sequence. The study primarily evaluated intubation performance, including total intubation time, and additionally assessed procedural performance, success, glottic visualization, and participant-reported workload and usability.
Detailed description
This prospective randomized 2 × 2 crossover simulation study included prehospital emergency care professionals with at least two years of field experience. Each participant performed endotracheal intubation under four experimental conditions: video laryngoscopy in a moving ambulance, augmented reality-assisted laryngoscopy in a moving ambulance, video laryngoscopy in a stationary ambulance, and augmented reality-assisted laryngoscopy in a stationary ambulance. The order of the study conditions was randomized. All procedures were performed using an adult airway management trainer. In the augmented reality condition, the laryngoscopic image was displayed within the participant's line of sight using AR smart glasses. Additional functions such as remote guidance or annotation were not used, allowing assessment of the effect of direct visualization through the head-mounted display. Moving ambulance scenarios were performed on a standardized 1-km ambulance training track at a constant speed of 20 km/h. The route included four speed bumps and four 90-degree turns, and the ambulance remained in motion until the intubation attempt was completed. Stationary scenarios were conducted using the same ambulance environment while the vehicle remained parked. Outcomes included total intubation time, time to glottic visualization, tube passage time, first-pass success, number of attempts, esophageal intubation, dental trauma, Cormack-Lehane grade, percentage of glottic opening (POGO), perceived difficulty, workload assessed using the NASA Task Load Index (NASA-TLX), ease of use, satisfaction, device preference, and safety or technical issues.
Interventions
DEVICEAugmented Reality-Assisted Laryngoscopy
Endotracheal intubation was performed using an augmented reality (AR) smart-glasses system that displayed the laryngoscopic video image within the participant's field of view. The system enabled participants to visualize the airway while maintaining a forward-facing head position. The intervention was evaluated under both stationary and moving ambulance conditions using an adult airway management trainer. Remote guidance and annotation functions were not used during the study.
DEVICEVideo Laryngoscopy
Endotracheal intubation was performed using a video laryngoscope (VL), with the airway image visualized on the device's external display. The intervention was evaluated under both stationary and moving ambulance conditions using an adult airway management trainer. Participants performed the intubation according to the randomized crossover sequence assigned to them.
Sponsors
ONUR KARAKAYALI
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Intervention model description
Participants completed all four experimental conditions in a randomized crossover design: video laryngoscopy (VL) and augmented reality-assisted laryngoscopy (AR) under both moving and stationary ambulance conditions. The order of the four conditions was randomized to minimize potential sequence and learning effects.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Prehospital emergency care professionals working as paramedics or emergency medical technicians (EMTs). * At least 2 years of professional experience in prehospital emergency medical services. * Aged 18 years or older. * Voluntary participation in the study and provision of informed consent.
Exclusion criteria
* Declining to participate or withdrawing consent. * Inability to complete all four randomized study conditions. * Incomplete study measurements or data preventing evaluation of the predefined outcomes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Intubation Time | During each of the four study conditions (periprocedural) | Time from insertion of the laryngoscope into the mouth until confirmation of successful endotracheal tube placement. Total intubation time was measured in seconds for each study condition. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Glottic Visualization | During each of the four study conditions (periprocedural) | Time from insertion of the laryngoscope into the mouth until adequate visualization of the glottis. The outcome was measured in seconds for each of the four study conditions. |
Countries
Turkey (Türkiye)
Outcome results
None listed