Video Analysis of Prehospital Emergency Intubations
6 maggio 2019 aggiornato da: University Hospital Inselspital, Berne
Evaluation of Prehospital Emergency Intubations Using Videolaryngoscopes
The Investigators' knowledge about pre-hospital emergency intubations is still limited.
Various factors such as the average and the normal range of intubation time are still unknown.
Since its launch Rega videotapes all intubation attempts with the C-MAC videolaryngoscope.
The investigators prospectively analysed all routinely recorded intubation videos during one year performed by the Rega crews.
The investigators analysed different parameters such as first pass success rate and the time to successfully intubate alongside with others.
The goal was to find out more about this difficult procedure, about the problems which regularly occur and on what should be put particular emphasis during training.
Panoramica dello studio
Stato
Completato
Condizioni
Descrizione dettagliata
Pre-hospital emergency intubations are especially hazardous. The incidence of unanticipated difficult airways is higher (9,3 % of prehospital intubations are more difficult than anticipated). The first attempt intubation success rates are lower and the rate of complications compared to in-hospital emergency intubations is higher.
There is conflicting evidence if first attempt intubation success rate in prehospital intubations differs between intubations performed by videolaryngoscopy and direct laryngoscopy. On the other hand in pre-hospital airway management, the use of a C-MAC videolaryngoscope improved the visualization of glottic structures significantly.
The C-MAC has recently launched a new version, which allows videotaping of intubations. Rega decided to videotape all intubation attempts for legal purposes and quality control. These videos are stored at a Rega-based secure central database.
The Investigators knowledge there is only one video-enhanced retrospective analyses of a limited number of videolaryngoscopic pre-hospital intubations.
So far, there is no video-enhanced prospective analysis of first attempt intubation success rates or of the time necessary for successful intubation with videolaryngoscopes in the pre-hospital setting available. Therefore, the investigators intend to determine the exact first attempt intubation success rate and the time necessary to successfully intubate, alongside with parameters such as the Cormack/Lehane grade, blade position (Macintosh vs Miller) and others (e.g. difficulties during intubation) in the pre-hospital physician-staffed HEMS-setting. The investigators' goal is to learn more about what is actually happening during prehospital intubations and what type of difficulties may occur.
The investigators therefore prospectively analysed all routinely recorded intubation videos (using the built-in camera of the C-MAC videolaryngoscope) during one year performed by the Rega crews. These videos show real life intubations through the video function included in the device, only the image from the tip of the laryngoscopy blade inside the patient's mouth is recorded. The operating physicians additionally provided anonymous information about intubation management for each video after returning to the helicopter base
Tipo di studio
Osservativo
Iscrizione (Effettivo)
422
Contatti e Sedi
Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.
Luoghi di studio
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Bern, Svizzera, 3011
- Bern University Hospital and University of Bern
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Criteri di partecipazione
I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.
Criteri di ammissibilità
Età idonea allo studio
- Bambino
- Adulto
- Adulto più anziano
Accetta volontari sani
No
Sessi ammissibili allo studio
Tutto
Metodo di campionamento
Campione non probabilistico
Popolazione di studio
All Patients which underwent Intubation performed by the Rega during 1year (15.02.18-14.02.19) because of medical or Trauma associated reasons (with or without cardiac arrest).
Descrizione
Inclusion Criteria:
• All videos routinely taken from intubations performed during 1 year at the Swiss Air Rescue (Rega) at all 13 helicopter bases
Exclusion Criteria:
- Patients who were intubated primarily using other devices without a camera
- Intubations that were not recorded (missing data).
Piano di studio
Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.
Come è strutturato lo studio?
Dettagli di progettazione
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
First attempt intubation success rate
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Rate of a successful intubation at first attempt
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Overall success rate
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
The overall rate of successful intubation
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Time intervals during intubation
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
entry-to-tube time (C-MAC crossing the lips to first appearance of tracheal tube in the field of view), time to intubation (C-MAC crossing the lips for the first time until passage of the tube through the vocal cords, the video is kept running throughout the intubation procedure), time between passage of the tube until removal of the blade from the mouth, overall time (from C-MAC crossing the lips for the first time until removal, the video is kept running throughout the intubation procedure), tube time (time from first appearance of the tube in the field until passage of the tube through the vocal cords), intubation time of the successful intubation attempt (C-MAC crossing the lips in the successful attempt until passage of the tube through vocal cords)
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
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Number of intubation attempts
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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The total number of attempts needed for the intubation
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Best C/L(Cormack/ Lehane 1-4) grade and best POGO (percent of glottis Opening 0 - 100 %) score
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
The best C/L and best POGO score achieved during the intubation
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Additional Airway devices used
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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If additional devices have been used (e.g.
Frova-like,catheter, Magill forceps, suction catheter)
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Number of glottic hits
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Number of attempts to advance the tracheal tube, but only glottic structures are being hit
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Blade positioning
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Blade positioning during intubation (Macintosh vs. Miller)
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Unintended blade positions
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Unintended blade positions (too deep, downfolding of epiglottis)
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Secretion in the mouth and difficulties in visualisation because of it
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Vomit, blood, saliva
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
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Fogging of the camera
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
|
videolaryngoscope camera clear or fog
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Oesophageal intubation
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Oesophageal fail intubation during the procedure
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Injury of the pharyngeal mucose due to the blade
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Videolaryngoscope injury of the pharyngeal mucose due to the blade
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Open or Closed vocal cords
Lasso di tempo: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Positioning of vocal cords if visible (open, closed), start of movement of vocal cords
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Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
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Collaboratori e investigatori
Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.
Investigatori
- Investigatore principale: Lorenz Theiler, Prof., Department of Anaesthesiology and Pain Therapy, Bern University Hospital
Pubblicazioni e link utili
La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.
Pubblicazioni generali
- Carlson JN, Quintero J, Guyette FX, Callaway CW, Menegazzi JJ. Variables associated with successful intubation attempts using video laryngoscopy: a preliminary report in a helicopter emergency medical service. Prehosp Emerg Care. 2012 Apr-Jun;16(2):293-8. doi: 10.3109/10903127.2011.640764. Epub 2011 Dec 22.
- Hossfeld B, Frey K, Doerges V, Lampl L, Helm M. Improvement in glottic visualisation by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study. Eur J Anaesthesiol. 2015 Jun;32(6):425-31. doi: 10.1097/EJA.0000000000000249.
- Kim SY, Park SO, Kim JW, Sung J, Lee KR, Lee YH, Hong DY, Baek KJ. How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation? Resuscitation. 2018 Dec;133:187-192. doi: 10.1016/j.resuscitation.2018.08.032. Epub 2018 Aug 30.
- Gunning M, O'Loughlin E, Fletcher M, Crilly J, Hooper M, Ellis DY. Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service. Emerg Med J. 2009 Jan;26(1):65-9. doi: 10.1136/emj.2008.059345.
- Smith CM, Yeung J. Airway management in cardiac arrest-Not a question of choice but of quality? Resuscitation. 2018 Dec;133:A5-A6. doi: 10.1016/j.resuscitation.2018.10.009. Epub 2018 Oct 15. No abstract available.
Studiare le date dei record
Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.
Studia le date principali
Inizio studio (Effettivo)
15 febbraio 2018
Completamento primario (Effettivo)
14 febbraio 2019
Completamento dello studio (Effettivo)
14 febbraio 2019
Date di iscrizione allo studio
Primo inviato
17 aprile 2019
Primo inviato che soddisfa i criteri di controllo qualità
24 aprile 2019
Primo Inserito (Effettivo)
29 aprile 2019
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
8 maggio 2019
Ultimo aggiornamento inviato che soddisfa i criteri QC
6 maggio 2019
Ultimo verificato
1 maggio 2019
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- 2017-02104
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Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
No
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
No
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .