Ability of paramedics to perform endotracheal intubation during continuous chest compressions: a randomized cadaver study comparing Pentax AWS and Macintosh laryngoscopes



      The aim of the trial was to compare the time parameters for intubation with the use of the Macintosh (MAC) laryngoscope and Pentax AWS-S100 videolaryngoscope (AWS; Pentax Corporation, Tokyo, Japan) with and without chest compression (CC) by paramedics during simulated cardiopulmonary resuscitation in a cadaver model.


      This was a randomized crossover cadaver trial. Thirty-five paramedics with no experience in videolaryngoscopy participated in the study. They performed intubation in two emergency scenarios: scenario A, normal airway without CC; scenario B, normal airway with continuous CC.


      The median time to first ventilation with the use of the AWS and the MAC was similar in scenario A: 25 (IQR, 22-27) seconds vs. 24 (IQR, 22.5-26) seconds (P = .072). A statistically significant difference in TTFV between AWS and MAC was noticed in scenario B (P = .011). In scenario A, the first endotracheal intubation (ETI) attempt success rate was achieved in 97.1% with AWS compared with 94.3% with MAC (P = .43). In scenario B, the success rate after the first ETI attempt with the use of the different intubation methods varied and amounted to 88.6% vs. 77.1% for AWS and MAC, respectively (P = .002).


      The Pentax AWS offered a superior glottic view as compared with the MAC laryngoscope, which was associated with a higher intubation rate and a shorter intubation time during an uninterrupted CC scenario. However, in the scenario without CC, the results for AWS and MAC were comparable.
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        • Soar J
        • Nolan JP
        • Böttiger BW
        • Perkins GD
        • Lott C
        • Carli P
        • et al.
        European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support.
        Resuscitation. 2015; 95: 100-147
        • Link MS
        • Berkow LC
        • Kudenchuk PJ
        • Halperin HR
        • Hess EP
        • Moitra VK
        • 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: S444-S464
        • Szarpak L
        • Truszewski Z
        • Czyzewski L
        • Gaszynski T
        • Rodríguez-Núñez A
        A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study.
        Am J Emerg Med. 2016; 34 ([pii: S0735–6757(15)01038–4]): 1338-1341
        • Overbeck MC
        Airway Management of Respiratory Failure.
        Emerg Med Clin North Am. 2016; 34: 97-127
        • Kurowski A
        • Szarpak L
        • Truszewski Z
        • Czyzewski L
        Can the ETView VivaSight SL rival conventional intubation using the Macintosh laryngoscope during adult resuscitation by novice physicians?: a randomized crossover manikin study.
        Medicine (Baltimore). 2015; 94: e850
        • Cook TM
        • Kelly FE
        The difficult airway society 2015 guidelines and the sacred cows of routine airway management.
        Anaesthesia. 2016; 71: 466-467
        • Cormack RS
        • Lehane J
        Difficult tracheal intubation in obstetrics.
        Anaesthesia. 1984; 39: 1105-1111
        • Wetsch WA
        • Spelten O
        • Hellmich M
        • Carlitscheck M
        • Padosch SA
        • Lier H
        • et al.
        Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial.
        Resuscitation. 2012; 83: 740-745
        • Lin PC
        • Ong J
        • Lee CL
        • Chen TY
        • Lee Y
        • Lai HY
        Comparisons of the GlideScope and Macintosh laryngoscope in tracheal intubation by medical students on fresh human cadavers.
        Tzu Chi Med J. 2009; 21: 147-150
        • Kern KB
        • Hilwig RW
        • Berg RA
        • Sanders AB
        • Ewy GA
        Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario.
        Circulation. 2002; 105: 645-649
        • Liu ZJ
        • Yi J
        • Guo WJ
        • Ma C
        • Huang YG
        Comparison of McGrath series 3 and Macintosh laryngoscopes for tracheal intubation in patients with normal airway by inexperienced anesthetists: a randomized study.
        Medicine (Baltimore). 2016; 95: e2514
        • Szarpak Ł
        • Czyżewski Ł
        • Kurowski A
        • Truszewski Z
        Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial.
        Eur J Pediatr. 2015; 174: 1325-1332
        • Pieters BM
        • Wilbers NE
        • Huijzer M
        • Winkens B
        • van Zundert AA
        Comparison of seven videolaryngoscopes with the Macintosh laryngoscope in manikins by experienced and novice personnel.
        Anaesthesia. 2016; 71: 556-564
        • Hippard HK
        • Kalyani G
        • Olutoye OA
        • Mann DG
        • Watcha MF
        A comparison of the Truview PCD and the GlideScope cobalt AVL video-laryngoscopes to the miller blade for successfully intubating manikins simulating normal and difficult pediatric airways.
        Paediatr Anaesth. 2016; 26: 613-620
        • Szarpak Ł
        • Czyżewski Ł
        • Kurowski A
        Comparison of the Pentax, Truview, GlideScope, and the miller laryngoscope for child intubation during resuscitation.
        Am J Emerg Med. 2015; 33: 391-395
        • Fujiwara S
        • Komasawa N
        • Matsunami S
        • Okada D
        • Minami T
        Comparison of Pentax-AWS Airwayscope and Glidescope for infant tracheal intubation by anesthesiologists during cardiopulmonary arrest simulation: a randomized crossover trial.
        Biomed Res Int. 2015; 2015: 190163
        • Komasawa N
        • Fujiwara S
        • Mihara R
        • Minami T
        Comparison of McGrath and Pentax-AWS Airwayscope for tracheal intubation by anaesthesiologists during chest compression in a manikin: a randomised crossover trial.
        Eur J Anaesthesiol. 2015; 32: 442-443
        • Kim W
        • Lee Y
        • Kim C
        • Lim TH
        • Oh J
        • Kang H
        • et al.
        Comparison of the Pentax Airwayscope, Glidescope video laryngoscope, and Macintosh laryngoscope during chest compression according to bed height.
        Medicine (Baltimore). 2016; 95: e2631
        • Bogdański Ł
        • Truszewski Z
        • Kurowski A
        • Czyżewski Ł
        • Zaśko P
        • Adamczyk P
        • et al.
        Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy laryngoscopes.
        Am J Emerg Med. 2015; 33: 1814-1817
        • Choi HY
        • Oh YM
        • Kang GH
        • Kang H
        • Jang YS
        • Kim W
        • et al.
        A randomized comparison simulating face to face endotracheal intubation of Pentax airway scope, C-MAC video laryngoscope, Glidescope video laryngoscope, and Macintosh laryngoscope.
        Biomed Res Int. 2015; 2015: 961782
        • Cho J
        • Chung HS
        • Chung SP
        • Kim YM
        • Cho YS
        Airway scope vs Macintosh laryngoscope during chest compressions on a fresh cadaver model.
        Am J Emerg Med. 2010; 28: 741-744
        • Kim YM
        • Kim JH
        • Kang HG
        • Chung HS
        • Yim HW
        • Jeong SH
        Tracheal intubation using Macintosh and 2 video laryngoscopes with and without chest compressions.
        Am J Emerg Med. 2011; 29: 682-686
        • Shimada M
        • Hirabayashi Y
        • Ehara T
        Tracheal intubation using the Pentax-AWS during chest compression: a meta-analysis.
        Masthead. 2015; 64: 873-878
        • Lee S
        • Kim W
        • Kang H
        • Oh J
        • Lim TH
        • Lee Y
        • et al.
        Comparisons of the Pentax-AWS, Glidescope, and Macintosh laryngoscopes for intubation performance during mechanical chest compressions in left lateral tilt: a randomized simulation study of maternal cardiopulmonary resuscitation.
        Biomed Res Int. 2015; 2015: 975649
        • Bossaert LL
        • Perkins GD
        • Askitopoulou H
        • Raffay VI
        • Greif R
        • Haywood KL
        • et al.
        European resuscitation council guidelines for resuscitation 2015: section 11. The ethics of resuscitation and end-of-life decisions.
        Resuscitation. 2015; 95: 302-311