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Are paramedics able to perform endotracheal intubation with access to the patient through the back seat of the car? Randomized crossover manikin study

Published:March 01, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.062
      Patients with trauma present unique airway management concerns. Conventional oral intubation with manual in-line stabilization (MILS) is still the most effective approach for early control of the airway in trauma [
      • Crosby E.T.
      Airway management in adults after cervical spine trauma.
      ]. However, there are situations in which access to the patient is difficult and direct viewing of the airways is impossible [
      • Green-Hopkins I.
      • Nagler J.
      Endotracheal Intubation In pediatric patients using video laryngoscopy: An evidence-based review.
      ,
      • Russo S.G.
      • Nickel E.A.
      • Leissner K.B.
      • Schwerdtfeger K.
      • Bauer M.
      • Roessler M.S.
      Use of the GlideScope®-ranger for pre-hospital intubations by anaesthesia trained emergency physicians - an observational study.
      ]. Such a situation might be encountered when a patient requires intubation when trapped in a vehicle [
      • Wetsch W.A.
      • Carlitscheck M.
      • Spelten O.
      • Teschendorf P.
      • Hellmich M.
      • Genzwürker H.V.
      • et al.
      Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim.
      ]. In such cases, alternative methods of endotracheal intubation can be used, including videolaryngoscopy or video tubes, ie, the ETView VivaSight-SL (ETView Ltd., Misgav, Israel).
      TableData from intubation with access from the back seat of the car scenario
      Parameter assessed MAC ETView P
      Time to intubation (s) 49 (41–63) 22.9 (20.4–26) <.001
      Overall success rate (%) 45 (100%) 45 (100%) NS
      Success rate of first attempt (%) 30 (66.7%) 45 (100%) 0.003
      Dental compression
      N - 42 (93.3%)
      1 33 (73.4%) 3 (6.7%) <.001
      2 11 (24.4%) -
      3 1 (2.2%) -
      Ease of intubation 6.5 (5–7) 2.5 (2–3.5) <.001
      Data reported as median (IQR) or number (%); NS = Not Statistically Significant; MAC = Macintosh laryngoscope; ETView = ETView VivaSight-SL.
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      References

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        Airway management in adults after cervical spine trauma.
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        Use of the GlideScope®-ranger for pre-hospital intubations by anaesthesia trained emergency physicians - an observational study.
        BMC Emerg Med. 2016; 16: 8https://doi.org/10.1186/s12873-016-0069-2
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        Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim.
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      1. Truszewski Z, Szarpak L, Smereka J, Kurowski A, Evrin T, Czyzewski L. Comparison of the VivaSight™ single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access. A randomized, crossover trial. Am J Emerg Med 2016. http://dx.doi.org/10.1016/j.ajem.2016.02.054 [pii: S0735-6757(16)00161-3].