Top

Published in:

Open Access 01-10-2015 | Original Article

Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial

Authors: Łukasz Szarpak, Łukasz Czyżewski, Andrzej Kurowski, Zenon Truszewski

Published in: European Journal of Pediatrics | Issue 10/2015

Abstract

The aim of the present study was to evaluate whether the TruView video laryngoscope (TruView) facilitates pediatric endotracheal intubation (ETI) more quickly and safely than conventional Macintosh laryngoscope (MAC) in three manikin-based airway scenarios. This was a randomized crossover manikin study including 120 novice paramedics. The participants performed tracheal intubations using both TruView and MAC on a pediatric manikin in a control scenario (A), chest compression scenario (B), and chest compression cervical stabilization scenario (C). The sequence of scenarios was randomized. The primary outcome was time to intubation. Secondary outcomes were overall success rates, incidence of dental trauma, and ease of intubation. All intubation attempts were assessed by a trained assistant. The overall success rate was significantly higher with the TruView compared than the MAC in scenario B (100 vs. 81.7 %; p = 0.011) and scenario C (100 vs. 68.3 %; p < 0.001). The intubation time was significantly lower with the TruView than the MAC (18.5 vs. 24.3 s, p = 0.017, for scenario A; 21.6 vs. 25.7 s, p = 0.023, for scenario B; and 28.9 vs. 45.4 s, p < 0.001, for scenario C). Glottic view quality was better with TruView than the MAC in all scenarios, p < 0.001.

Conclusions: The TruView offers better intubation conditions than the MAC on a pediatric manikin in the control scenario, chest compression scenario, and chest compression scenario with cervical stabilization scenario. The TruView may be used to elevate the epiglottis for orotracheal intubation. Further clinical studies are necessary to confirm these initial positive findings.

Trial Registration: clinicaltrials.gov Identifier: NCT02289872.

What is Known:

•Prehospital pediatric intubation using a standard laryngoscope is varied and ranges from 63.4 to 82 %.

What is New:

•This is the first study showing efficiency of pediatric endotracheal intubation using the TruView PCD by paramedics in tree simulation scenarios.

•TruView PCD offers better pediatric intubation conditions than the Macintosh laryngoscope.

Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D (2010) European resuscitation council guidelines for resuscitation 2010 section 6. Paediatric life support. Resuscitation 81(10):1364–88. doi:10.1016/j.resuscitation.2010.08.012 CrossRefPubMed

Bouillon B, Probst C, Maegele M, Wafaisade A, Helm P, Mutschler M, Brockamp T, Shafizadeh S, Paffrath T (2013) Emergency room management of multiple trauma: ATLS® and S3 guidelines. Chirurg 84(9):745–52. doi:10.1007/s00104-013-2476-1 CrossRefPubMed

Choi HJ, Je SM, Kim JH, Kim E, Korean Emergency Airway Registry Investigators (2012) The factors associated with successful paediatric endotracheal intubation on the first attempt in emergency departments: a 13-emergency-department registry study. Resuscitation 83(11):1363–1368. doi:10.1016/j.resuscitation.2012.03.010 CrossRefPubMed

Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39(11):1105–11CrossRefPubMed

De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, Jung B, Chanques G, Jaber S (2014) Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med 40(5):629–39. doi:10.1007/s00134-014-3236-5 PubMed

Gaszynska E, Gaszynski T (2014) Truview EVO2 and standard macintosh laryngoscope for tracheal intubation during cardiopulmonary resuscitation: a comparative randomized crossover study. Medicine (Baltimore) 93(14), e78. doi:10.1097/MD.0000000000000078 CrossRef

Gaszyński T (2014) Local anaesthesia for ‘awake intubation’ using the TruView PCD video laryngoscope. Anaesthesiol Intensive Ther 46(3):210–1PubMed

Gerritse BM, Draaisma JM, Schalkwijk A, van Grunsven PM, Scheffer GJ (2008) Should EMS-paramedics perform paediatric tracheal intubation in the field? Resuscitation 79(2):225–229. doi:10.1016/j.resuscitation.2008.05.016 CrossRefPubMed

Gerritse BM, Schalkwijk A, Pelzer BJ, Scheffer GJ, Draaisma JM (2010) Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service. BMC Emerg Med 10:6. doi:10.1186/1471-227X-10-6 PubMedCentralCrossRefPubMed

10.

Harrison TH, Thomas SH, Wedel SK (2004) Success rates of pediatric intubation by a non-physician-staffed critical care transport service. Pediatr Emerg Care 20(2):101–7CrossRefPubMed

11.

Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL (2010) Part 14: pediatric advanced life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(18 Suppl 3):S876–908. doi:10.1161/CIRCULATIONAHA.110.971101 CrossRefPubMed

12.

Komasawa N, Ueki R, Kaminoh Y, Nishi SI (2015) Comparison of the Miller Laryngoscope and Videolaryngoscope for Tracheal Intubation by Novice Doctors during Neonatal Cardiopulmonary Resuscitation: A Randomized Crossover Simulation Trial. Am J Perinatol 2015 Jan 16

13.

Koyama J, Iwashita T, Okamoto K (2010) Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: a manikin study. Resuscitation 81(9):1172–4. doi:10.1016/j.resuscitation.2010.05.020 CrossRefPubMed

14.

Kriege M, Piepho T, Buggenhagen H, Noppens RR (2015) Comparison of GlideScope® Cobalt and McGrath® Series 5 video laryngoscopes with direct laryngoscopy in a simulated regurgitation/aspiration scenario. Med Klin Intensivmed Notfmed 2015 Jan 11

15.

Kurowski A, Hryniewicki T, Czyżewski L, Karczewska K, Evrin T, Szarpak Ł (2014) Simulation of blind tracheal intubation during pediatric cardiopulmonary resuscitation. Am J Respir Crit Care Med 190(11):1315. doi:10.1164/rccm.201409-1635LE CrossRefPubMed

16.

Lee DH, Han M, An JY, Jung JY, Koh Y, Lim CM, Huh JW, Hong SB (2014) Video laryngoscopy versus direct laryngoscopy for tracheal intubation during in-hospital cardiopulmonary resuscitation. Resuscitation. 2014 Dec 22. pii: S0300-9572(14)00892-2. doi: 10.1016/j.resuscitation.2014.11.030

17.

Lippert FK, Raffay V, Georgiou M, Steen PA, Bossaert L (2010) European resuscitation council guidelines for resuscitation 2010 section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation 81(10):1445–51. doi:10.1016/j.resuscitation.2010.08.013 CrossRefPubMed

18.

Liu KP, Li CH, Xue FS (2013) Comparison between the truview PCD™ or the GlideScope® video laryngoscope and direct laryngoscopy for tracheal intubation in pediatric patients. Can J Anaesth 60(7):735–6. doi:10.1007/s12630-013-9943-5 CrossRefPubMed

19.

Mosier JM, Whitmore SP, Bloom JW, Snyder LS, Graham LA, Carr GE, Sakles JC (2013) Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit. Crit Care 17(5):R237. doi:10.1186/cc13061 PubMedCentralCrossRefPubMed

20.

Mutlak H, Rolle U, Rosskopf W, Schalk R, Zacharowski K, Meininger D, Byhahn C (2014) Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct macintosh laryngoscopy for routine tracheal intubation in infants with normal airways. Clinics (Sao Paulo) 69(1):23–7. doi:10.6061/clinics/2014(01)04 CrossRef

21.

Nileshwar A, Garg V (2010) Comparison of Bullard laryngoscope and short-handled macintosh laryngoscope for orotracheal intubation in pediatric patients with simulated restriction of cervical spine movements. Paediatr Anaesth 20(12):1092–7. doi:10.1111/j.1460-9592.2010.03439.x CrossRefPubMed

22.

Nordberg M (1996) When Johnny can’t breathe. Should paramedics perform pediatric intubation in the field? Emerg Med Serv 25(10):22, 24, 26

23.

Passi Y, Sathyamoorthy M, Lerman J, Heard C, Marino M (2014) Comparison of the laryngoscopy views with the size 1 miller and macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age. Br J Anaesth 113(5):869–74. doi:10.1093/bja/aeu228 CrossRefPubMed

24.

Piepho T, Weinert K, Heid FM, Werner C, Noppens RR (2011) Comparison of the McGrath® series 5 and GlideScope® ranger with the macintosh laryngoscope by paramedics. Scand J Trauma Resusc Emerg Med 19:4PubMedCentralCrossRefPubMed

25.

Park SO, Kim JW, Na JH, Lee KH, Lee KR, Hong DY, Baek KJ (2014) Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians. Resuscitation. 2014 Dec 22. pii: S0300-9572(14)00893-4. doi: 10.1016/j.resuscitation.2014.12.010

26.

Riveros R, Sung W, Sessler DI, Sanchez IP, Mendoza ML, Mascha EJ, Niezgoda J (2013) Comparison of the truview PCD™ and the GlideScope(®) video laryngoscopes with direct laryngoscopy in pediatric patients: a randomized trial. Can J Anaesth 60(5):450–7. doi:10.1007/s12630-013-9906-x CrossRefPubMed

27.

Rodríguez-Núñez A, Moure-González J, Rodríguez-Blanco S, Oulego-Erroz I, Rodríguez-Rivas P, Cortiñas-Díaz J (2014) Tracheal intubation of pediatric manikins during ongoing chest compressions. Does Glidescope® videolaryngoscope improve pediatric residents’ performance? Eur J Pediatr 173(10):1387–90. doi:10.1007/s00431-014-2329-z CrossRefPubMed

28.

Sakles JC, Patanwala AE, Mosier JM, Dicken JM (2014) Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. Intern Emerg Med 9(1):93–8. doi:10.1007/s11739-013-0995-x CrossRefPubMed

29.

Savoldelli GL, Schiffer E, Abegg C, Baeriswyl V, Clergue F, Waeber JL (2009) Learning curves of the GlideScope, the McGrath and the airtraq laryngoscopes: a manikin study. Eur J Anaesthesiol 26(7):554–8CrossRefPubMed

30.

Schmidt AR, Weiss M, Engelhardt T (2014) The paediatric airway: basic principles and current developments. Eur J Anaesthesiol 31(6):293–9. doi:10.1097/EJA.0000000000000023 CrossRefPubMed

31.

Silverberg MJ, Li N, Acquah SO, Kory PD (2014) Comparison of Video Laryngoscopy Versus Direct Laryngoscopy During Urgent Endotracheal Intubation: A Randomized Controlled Trial. Crit Care Med 2014 Dec 4

32.

Szarpak L, Czyżewski L, Kurowski A (2015) Can GlideScope® videolaryngoscope be an alternative to direct laryngoscopy for child and infant tracheal intubation during chest compression? Eur J Pediatr. 2015 Jan 31. doi: 10.1007/s00431-015-2495-7

33.

Szarpak L, Czyzewski L, Kurowski A (2014) Comparison of the Pentax, Truview, GlideScope and the Miller laryngoscope for child intubation during resuscitation. Am J Emerg Med. doi:10.1016/j.ajem.2014.12.020

34.

Szarpak L, Czyżewski L, Kurowski A (2014) Can BONFILS Intubation Endoscope be an alternative to direct laryngoscopy for pediatric tracheal intubation during resuscitation? Am J Emerg Med. doi: 10.1016/j.ajem.2014.10.052

35.

Tollefsen WW, Brown CA III, Cox KL, Walls RM (2011) Out-of-hospital pediatric endotracheal intubation by Air transport providers results of the national emergency airway (NEAR) Vi database. Ann Emerg Med 58(4):S243CrossRef

36.

Van Zundert AA, Pieters BM (2015) Videolaryngoscopy offers us more than classic direct laryngoscopy. Minerva Anestesiol. 2015 Feb 13

37.

Varghese E, Kundu R (2014) Does the miller blade truly provide a better laryngoscopic view and intubating conditions than the macintosh blade in small children? Paediatr Anaesth 24(8):825–9. doi:10.1111/pan.12394 CrossRefPubMed

38.

Vilke GM, Steen PJ, Smith AM, Chan TC (2002) Out-of-hospital pediatric intubation by paramedics: the San Diego experience. J Emerg Med 22(1):71–74CrossRefPubMed

39.

Xanthos T, Stroumpoulis K, Bassiakou E, Koudouna E, Pantazopoulos I, Mazarakis A, Demestiha T, Iacovidou N (2011) Glidescope(®) videolaryngoscope improves intubation success rate in cardiac arrest scenarios without chest compressions interruption: a randomized cross-over manikin study. Resuscitation 82(4):464–7. doi:10.1016/j.resuscitation.2010.12.011 CrossRefPubMed

Title: Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial
Authors: Łukasz Szarpak
Łukasz Czyżewski
Andrzej Kurowski
Zenon Truszewski
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 10/2015
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-015-2538-0

At a glance: The STEP trials

Springer Medicine

Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2015

Obesity increases the risk of renal involvement in children with Henoch–Schönlein purpura

Childhood diagnosis of genetic thrombocytopenia with mutation in the ankyrine repeat domain 26 gene

The utility of bioimpedance analysis for monitoring the children with nutcracker syndrome

Novel mutations associated with nephrogenic diabetes insipidus. A clinical-genetic study

Performance of PRISM III and PELOD-2 scores in a pediatric intensive care unit

Incidence of type 1 diabetes mellitus during 26 years of observation and prevalence of diabetic ketoacidosis in the later years