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Comparison of two types of laryngoscopy for face-to-face intubation of a patient entrapped in a vehicle

Published:February 03, 2018DOI:https://doi.org/10.1016/j.ajem.2018.01.099
      Emergency Medical Service teams help victims of traffic accidents, who often experience a cervical spine and head injury [
      • Taghavi S.
      • Vora H.P.
      • Jayarajan S.N.
      • Gaughan J.P.
      • Pathak A.S.
      • Santora T.A.
      • et al.
      Prehospital intubation does not decrease complications in the penetrating trauma patient.
      ]. Due to injury to the central nervous system and impaired consciousness, such patients may develop airway obstruction. If it happens the golden standard for protection of airway patency is endotracheal intubation, which allows for long-term airway patency maintenance, ventilation of the patient during extraction from the vehicle and during transportation to the hospital. In the case of patients stuck in a vehicle requiring endotracheal intubation for restoring airway patency, the endotracheal intubation can be performed using face-to-face technique [
      • 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.
      ]. However, as numerous studies show, when there is a difficult access to the patient's airways the efficacy of endotracheal intubation with Macintosh laryngoscope is insufficient [
      • 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.
      • Sierzantowicz R.
      • Kedziora J.
      • Szarpak L.
      Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation.
      ,
      • Smereka J.
      • Czyzewski L.
      • Szarpak L.
      • Ladny J.R.
      Comparison between the TrueView EVO2 PCD and direct laryngoscopy for endotracheal intubation performed by paramedics: preliminary data.
      ]. Studies show that is such a case, the use of video laryngoscopy may increase the effectiveness of endotracheal intubation [
      • Ladny J.R.
      • Smereka J.
      • Szarpak L.
      Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation.
      ,
      • Truszewski Z.
      • Szarpak Ł.
      • Smereka J.
      • Kurowski A.
      • Evrin T.
      • Czyzewski Ł.
      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.
      ,
      • Buljan D.
      • Rosiczuk J.
      • Stawicka I.
      Evaluation of the effectiveness of selected techniques for endotracheal intubation in conditions of simulated resuscitation performed by nurses.
      ]. The aim of this study was to compare the effectiveness of the first face-to-face intubation attempt using the Macintosh laryngoscope and the first attempt using McGrath MAC videolaryngoscope.
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        Prehospital intubation does not decrease complications in the penetrating trauma patient.
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