COMPARISON OF FOUR LARYNGOSCOPES FOR OROTRACHEAL INTUBATION BY NURSES DURING RESUSCITATION WITH AND WITHOUT CHEST COMPRESSIONS: A RANDOMIZED CROSSOVER MANIKIN TRIAL

Abstract

BACKGROUND: Currently, the gold standard for airway management in cardiopulmonary resuscitation is endotra- cheal intubation. This should be performed without interruptions in chest compressions, or with a short break only to introduce the tube.

METHODS: A total of 47 nurses were recruited who performed endotracheal intubation on a manikin in 2 scenar- ios: A — normal airway, without chest compressions; B — normal airway, with continuous chest compressions performed with the Lifeline ARM system. They used 4 devices: a Macintosh blade laryngoscope (MAC), and a Tru- View EVO2 (EVO2), TruView EVO2 PCD (PCD), and an ETView SL (ETView) laryngoscope. The intubation time and effectiveness, the grade of larynx visibility, and the ease of intubation in adults were compared.

RESULTS: The median time to rst ventilation in scenario A was: for the MAC, 30.5 (interquartile range [IQR], 27– –36.5); for the EVO2, 35.5 (IQR, 32–39.5): for the PCD, 26.5 (IQR, 25–28.5); and for the ETView, 23 (22–24.5)’]; in scenario B: for the MAC, 47.5 (IQR, 37.5–51); for the EVO2, 42.5 (IQR, 39–47.5): for the PCD, 29.5 (IQR, 28–33); and for the ETView, 26 (IQR, 23–30.5) seconds]. The rst inbunation attempt success rate in scrnario A was: for the MAC, 44.7%; for the EVO2, 68.8%; for the PCD, 82.9%; and for the ETView, 91.5%; in scenario B: for the MAC, 38.3%; for the EVO2, 61.7%; for the PCD, 70.2%; and for the ETView 89.4%.

CONCLUSIONS: The ef cacy of endotracheal intubation by nurses turned out to be insuf cient. Ongoing chest compressions signi cantly reduced the intubation effectiveness with the MAC. After a short training session, nurses could perform intubation with videolaryngoscopes. ETView appeared to be the most effective method in both scenarios.