Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment

Lukasz Szarpak, Frank W Peacock, Zubaid Rafique, Jerzy R Ladny, Klaudiusz Nadolny, Marek Malysz, Marek Dabrowski, Francesco Chirico, Jacek Smereka, Lukasz Szarpak, Frank W Peacock, Zubaid Rafique, Jerzy R Ladny, Klaudiusz Nadolny, Marek Malysz, Marek Dabrowski, Francesco Chirico, Jacek Smereka

Abstract

Background: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE).

Methods: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers.

Results: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001).

Conclusions: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures.

Trial registration: ClinicalTrials registration number NCT04365608.

Keywords: Airway management; COVID-19; Cardiopulmonary resuscitation; Endotracheal intubation; Personal protective equipment; SARS-CoV-2.

Conflict of interest statement

Declaration of Competing Interest None.

Copyright © 2022 Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Vie Scope® laryngoscope.Flow diagram of the study.
Fig. 2
Fig. 2
Flow diagram of the study.
Fig. 3
Fig. 3
Paramedic wearing personal protective equipment.

References

    1. Dzieciatkowski T., Szarpak L., Filipiak K.J., Jaguszewski M., Ladny J.R., Smereka J. COVID-19 challenge for modern medicine. Cardiol J. 2020;27(2):175–183.
    1. Smereka J., Szarpak L. The use of personal protective equipment in the COVID-19 pandemic era. Am J Emerg Med. 2020;38(7):1529–1530.
    1. Malysz M., Jaguszewski M.J., Szarpak L., et al. Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial. Disaster Emerg Med J. 2020;5(3):127–133. doi: 10.5603/DEMJ.a2020.0034.
    1. Tang S., Mao Y., Jones R.M., et al. Aerosol transmission of SARS-CoV-2? Evidence, prevention and control. Environ Int. 2020;144
    1. Zuo Y.Y., Uspal W.E., Wei T. Airborne transmission of COVID-19: aerosol dispersion, lung deposition, and virus-receptor interactions. ACS Nano. 2020:1–12. [Nov 25 : acsnano.0c08484. Published online 2020 Nov 25]
    1. Gadek L., Szarpak L., Konge L., et al. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J Clin Med. 2021;10(24):5740. doi: 10.3390/jcm10245740.
    1. Attila K., Ludwin K., Evrin T., et al. The impact of COVID-19 on airway management in prehospital resuscitation. Disaster Emerg Med J. 2020;5(4):216–217.
    1. Szarpak L., Drozd A., Smereka J. Airway management and ventilation principles in COVID-19 patients. J Clin Anesth. 2020;65
    1. Link M.S., Berkow L.C., Kudenchuk P.J., 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(18 Suppl. 2) (S444–64. Correction in: Circulation 2015; 132(24):e385)
    1. Ludwin K., Bialka S., Czyzewski L., et al. Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials. Disaster. Emerg Med J. 2020;5(2):85–97.
    1. Maslanka M., Szarpak L., Ahuja S., Ruetzler K., Smereka J. Novel airway device Vie Scope in several pediatric airway scenario: a randomized simulation pilot trial. Medicine (Baltimore) 2020;99(28)
    1. Maslanka M., Smereka J., Czyzewski L., Ladny J.R., Dabrowski M., Szarpak L. Vie scope laryngoscope versus Macintosh laryngoscope with personal protective equipment during intubation of COVID-19 resuscitation patient. Am J Emerg Med. 2020;(20) Sep 4:S0735-6757. (30779–8)
    1. Malysz M., Dabrowski M., Böttiger B.W., et al. Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: a randomized multicenter crossover simulation trial. Cardiol J. 2020;27(5):497–506. doi: 10.5603/CJ.a2020.0068.
    1. Soar J., Nolan J.P., Böttiger B.W., et al. European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support Resuscitation. 2015;95:100–147. doi: 10.1016/j.resuscitation.2015.07.016.
    1. Malik M.A., Subramaniam R., Maharaj C.H., et al. Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation. Br J Anaesth. 2009;103:761–768.
    1. Maharaj C.H., Costello J.F., Harte B.H., Laffey J.G. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia. 2008;63:182–188.
    1. Aziz M.F., Dillman D., Fu R., et al. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012;116(3):629–636.
    1. Sakles J.C., Chiu S., Mosier J., Walker C., Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20:71–78.
    1. Ducharme S., Kramer B., Gelbart D., Colleran C., Risavi B., Carlson J.N. A pilot, prospective, randomized trial of video versus direct laryngoscopy for paramedic endotracheal intubation. Resuscitation. 2017;114:121–126.

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