Vol 5, No 1 (2020)
Research paper
Published online: 2020-01-13

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Efficacy of double-lumen intubation performed by paramedics on patients with lung damage. Experimental, pilot simulation trial

Katarzyna Karczewska1, Jacek Smereka2, Lukasz Szarpak3, Kurt Ruetzler4, Szymon Bialka5
Disaster Emerg Med J 2020;5(1):7-11.


INTRODUCTION: The airway management and the implementation of optimal oxygen therapy in trauma patients, especially unconscious ones, is a key element of prehospital management. However, in cases of trauma lung or bronchial rupture, both lungs ventilation may not be advisable. In such cases, intubation with a double-lumen endotracheal tube may be helpful, allowing to provide one-lung ventilation. The aim of the experimental study was to assess the impact of short training in intubation using double-lumen tubes on the effectiveness of intubation performance and one-lung ventilation by paramedics in a simulated trauma patient setting.

MATERIAL AND METHODS: This was a prospective, observational, randomized experimental trial. The study involved 30 paramedics. The participants had to perform tracheal intubation using Double Lumen Tube VivaSight-DL (VS-DL; ETView Ltd.; Misgav, Israel) under normal airway conditions. The effectiveness of the first intubation attempt, the time of intubation and the Cormack-Lehane scale were evaluated.

RESULTS: The effectiveness of the first attempt at intubation with a double-lumen tube was 90% and the total effectiveness of intubation was 100%. The median time of the procedure was 63 (IQR; 38–72.5) seconds.

CONCLUSIONS: In the simulation study, the paramedics were able to intubate using a double tube after a short training.

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  1. Umobong EU, Mayo PH. Critical Care Airway Management. Crit Care Clin. 2018; 34(3): 313–324.
  2. Simma L, Cincotta D, Sabato S, et al. Airway emergencies presenting to the paediatric emergency department requiring advanced management techniques. Arch Dis Child. 2017; 102(9): 809–812.
  3. Szarpak L. Laryngoscopes for difficult airway scenarios: a comparison of the available devices. Expert Rev Med Devices. 2018; 15(9): 631–643.
  4. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S444–S464.
  5. Soar J, Nolan JP, Böttiger BW, et al. Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–147.
  6. Welter S, Hoffmann H. [Injuries to the tracheo-bronchial tree]. Zentralbl Chir. 2013; 138(1): 111–116.
  7. Galvagno SM, Nahmias JT, Young DA. Advanced Trauma Life Support Update 2019: Management and Applications for Adults and Special Populations. Anesthesiol Clin. 2019; 37(1): 13–32.
  8. ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013; 74(5): 1363–1366.
  9. Glosser L. Assessment of endotracheal tube intubation. Review of existing scales. Disaster and Emergency Medicine Journal. 2017; 2(2): 91–93.
  10. Levy-Faber D, Malyanker Y, Nir RR, et al. Comparison of VivaSight double-lumen tube with a conventional double-lumen tube in adult patients undergoing video-assisted thoracoscopic surgery. Anaesthesia. 2015; 70(11): 1259–1263.
  11. Hung KC. Trachway video stylet use in double lumen tube insertion. Anaesthesia. 2015; 70(9): 1093–1094.
  12. Palczynski P, Bialka S, Misiolek H, et al. Thyromental height test as a new method for prediction of difficult intubation with double lumen tube. PLoS One. 2018; 13(9): e0201944.
  13. Templeton TW, Morris BN, Royster RL. The Video Double-Lumen Endobronchial Tube: Is the Benefit Worth the Cost? J Cardiothorac Vasc Anesth. 2018; 32(1): 275–276.
  14. Szarpak L, Kurowski A, Zaśko P, et al. Double-lumen tube tracheal intubation in a manikin model using the VivaSight Double Lumen: a randomized controlled comparison with the Macintosh laryngoscope. Am J Emerg Med. 2016; 34(1): 103–104.
  15. Latif RK, VanHorne EM, Kandadai SK, et al. Teaching basic lung isolation skills on human anatomy simulator: attainment and retention of lung isolation skills. BMC Anesthesiol. 2016; 16: 7.
  16. Cerfolio RJ, Smood B, Ghanim A, et al. Decreasing Time to Place and Teach Double-Lumen Endotracheal Intubation: Engaging Anesthesia in Lean. Ann Thorac Surg. 2018; 106(5): 1512–1518.
  17. Foley ED, Odo N, Arthur ME. Developing Modules to Train Anesthesiology Residents & Medical Students in a Lung Isolation Technique. J Educ Perioper Med. 2017; 19(2): E602.
  18. Failor E, Bowdle A, Jelacic S, et al. High-fidelity simulation of lung isolation with double-lumen endotracheal tubes and bronchial blockers in anesthesiology resident training. J Cardiothorac Vasc Anesth. 2014; 28(4): 865–869.
  19. Hirsch J, Generoso JR, Latoures R, et al. Simulation Manikin Modifications for High-Fidelity Training of Advanced Airway Procedures. A A Case Rep. 2016; 6(9): 268–271.
  20. Chang JE, Kim H, Min SW, et al. A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and GlideScope for Double-Lumen Endobronchial Intubation. J Cardiothorac Vasc Anesth. 2018; 32(1): 290–296.
  21. El-Tahan MR, Khidr AM, Gaarour IS, et al. A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study. J Cardiothorac Vasc Anesth. 2018; 32(1): 277–286.
  22. Bakshi SG, Gawri A, Divatia JV. McGrath MAC video laryngoscope versus direct laryngoscopy for the placement of double-lumen tubes: A randomised control trial. Indian J Anaesth. 2019; 63(6): 456–461.
  23. Langiano N, Fiorelli S, Deana C, et al. Airway management in anesthesia for thoracic surgery: a "real life" observational study. J Thorac Dis. 2019; 11(8): 3257–3269.
  24. Yoo JiY, Chae YJ, Park SY, et al. Time to tracheal intubation over a fibreoptic bronchoscope using a silicone left double-lumen endobronchial tube versus polyvinyl chloride single-lumen tube with bronchial blocker: a randomized controlled non-inferiority trial. J Thorac Dis. 2019; 11(3): 901–908.
  25. Abelsson A. Learning through simulation. Disaster and Emergency Medicine Journal. 2017; 2(3): 125–128.
  26. Frass M, Smereka J, Ruetzler K, et al. New Flexible Tip Bougie catheter for difficult airway intubation. A randomized, crossover pilot study. Disaster and Emergency Medicine Journal. 2019; 4(2): 50–54.
  27. Truszewski Z, Czyzewski L, Smereka J, et al. Ability of paramedics to perform endotracheal intubation during continuous chest compressions: a randomized cadaver study comparing Pentax AWS and Macintosh laryngoscopes. Am J Emerg Med. 2016; 34(9): 1835–1839.

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