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The efficacy of endotracheal intubation utilizing INTUBRITE laryngoscope during cardiopulmonary resuscitation

Published:February 02, 2018DOI:https://doi.org/10.1016/j.ajem.2018.01.081
      We have read with great interest an article “Comparison of the Intubrite and Macintosh laryngoscope in difficult airway scenario” in which the authors compared the efficacy of video laryngoscopy and direct laryngoscopy [
      • Smereka J.
      • Ladny J.R.
      • Szarpak L.
      Comparison of the Intubrite and Macintosh laryngoscopes in a difficult airway scenario.
      ]. They showed that the use of video laryngoscopy increases the effectiveness of endotracheal intubation in conditions of difficult airways. In the reality of emergency medical service endotracheal intubation, due to widespread availability, is a gold standard for the protection of airways. However, as indicated by numerous studies, endotracheal intubation should be performed by the most experienced person in the rescue team [
      • 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.
      ,
      • Cavus E.
      • Janssen S.
      • Reifferscheid F.
      • Caliebe A.
      • Callies A.
      • von der Heyden M.
      • et al.
      Videolaryngoscopy for physician-based, prehospital emergency intubation: a prospective, randomized, multicenter comparison of different blade types using A.P. Advance, C-MAC System, and KingVision.
      ]. Unfortunately besides the obvious benefits of maintaining airway patency with this method e.g. possibility of positive pressure ventilation, there are also numerous potential complications when performing this procedure. When poorly performed it can lead to tissue damage, cause bleeding, as well as dislocation of artenoid cartilage, breakage or epiglottis, rupture of vocal folds or trachea and formation of pneumomediastinum. Due to the high learning curve of direct laryngoscopy [
      • Aghamohammadi H.
      • Massoudi N.
      • Fathi M.
      • Jaffari A.
      • Gharaei B.
      • Moshki A.
      Intubation learning curve: comparison between video and direct laryngoscopy by inexperienced students.
      ], the use of video laryngoscopy, as indicated by numerous studies, may increase the effectiveness of this procedure, especially when performed by people who have limited experience in direct laryngoscopy. Many studies confirm that people without previous experience in video laryngoscopy after completing a short training are able to perform intubation with high efficiency [
      • Smereka J.
      • Ladny J.R.
      • Naylor A.
      • Ruetzler K.
      • Szarpak L.
      C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: a manikin trial.
      ,
      • Ladny J.R.
      • Smereka J.
      • Szarpak L.
      Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data.
      ,
      • Ladny J.R.
      • Sierzantowicz R.
      • Kedziora J.
      • Szarpak L.
      Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation.
      ,
      • Bielski K.
      • Smereka J.
      • Ladny J.R.
      • Szarpak L.
      A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: a randomized crossover manikin study.
      ].
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