Lukasz Szarpak1, Zenon Truszewski2, Lukasz Czyzewski3, Tomasz Gaszynski4, Antonio Rodríguez-Núñez5. 1. Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. 2. Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: zetrtrusz@gmail.com. 3. Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland. 4. Department of Emergency Medicine Disaster Medicine, Medical University of Lodz, Lodz, Poland. 5. Pediatric Emergency and Critical Care Division and Institute of Investigation of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS, CLINURSID Investigation Group, Nursing Department, Universidade de Santiago de Compostela, SAMID Network, Madrid, Spain.
Abstract
INTRODUCTION:Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin. METHODS: This was an open, prospective, randomized, crossover, manikin trial involving 95 paramedics who performed intubations in a PediaSIM pediatric high-fidelity manikin with Macintosh and McGrath laryngoscopes, with and without concomitant mechanical CCs. Primary outcome was the TTI, and secondary outcome was success of the attempt. Participants rated their best glottic view, the severity of the potential dental trauma, and subjective opinion about the difficulty of the procedure. RESULTS: The median TTI with the Macintosh in the scenario with uninterrupted CC was 33 (interquartile range [IQR], 24-36) seconds, which is significantly longer than TTI in the scenario with interrupted CC (23 [IQR, 20-29] seconds, P < .001). Time to intubation using the McGrath was similar in both scenarios: 20 (IQR, 17-23) seconds vs 19.5 (IQR, 17-22) seconds (P = .083). A statistically significant difference between McGrath and Macintosh was noticed in TTI both in scenario with (P < .001) and without CC (P = .017). CONCLUSIONS: McGrath video laryngoscope helps paramedics to intubate a pediatric manikin in a CPR scenario in less time and with fewer attempts than with the classical Macintosh, both in case of ongoing or stopped CC. McGrath use in actual patients could improve CPR quality by paramedics.
RCT Entities:
INTRODUCTION: Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin. METHODS: This was an open, prospective, randomized, crossover, manikin trial involving 95 paramedics who performed intubations in a PediaSIM pediatric high-fidelity manikin with Macintosh and McGrath laryngoscopes, with and without concomitant mechanical CCs. Primary outcome was the TTI, and secondary outcome was success of the attempt. Participants rated their best glottic view, the severity of the potential dental trauma, and subjective opinion about the difficulty of the procedure. RESULTS: The median TTI with the Macintosh in the scenario with uninterrupted CC was 33 (interquartile range [IQR], 24-36) seconds, which is significantly longer than TTI in the scenario with interrupted CC (23 [IQR, 20-29] seconds, P < .001). Time to intubation using the McGrath was similar in both scenarios: 20 (IQR, 17-23) seconds vs 19.5 (IQR, 17-22) seconds (P = .083). A statistically significant difference between McGrath and Macintosh was noticed in TTI both in scenario with (P < .001) and without CC (P = .017). CONCLUSIONS: McGrath video laryngoscope helps paramedics to intubate a pediatric manikin in a CPR scenario in less time and with fewer attempts than with the classical Macintosh, both in case of ongoing or stopped CC. McGrath use in actual patients could improve CPR quality by paramedics.
Authors: Jolanta Majer; Milosz J Jaguszewski; Michael Frass; Marcin Leskiewicz; Jacek Smereka; Jerzy R Ładny; Oliver Robak; Łukasz Szarpak Journal: Cardiol J Date: 2018-08-29 Impact factor: 2.737
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Authors: Lukasz Szarpak; Agnieszka Madziala; Michael Czekajlo; Jacek Smereka; Alexander Kaserer; Marek Dabrowski; Marcin Madziala; Ruslan Yakubtsevich; Jerzy Robert Ladny; Kurt Ruetzler Journal: Medicine (Baltimore) Date: 2018-09 Impact factor: 1.817