Cavus, Erol;
Janssen, Sebastian;
Reifferscheid, Florian;
Caliebe, Amke;
Callies, Andreas;
von der Heyden, Martin;
Knacke, Peer G.;
Doerges, Volker
Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter Comparison of Different Blade Types Using A.P. Advance, C-MAC System, and KingVision
Sie können Bookmarks mittels Listen verwalten, loggen Sie sich dafür bitte in Ihr SLUB Benutzerkonto ein.
Medientyp:
E-Artikel
Titel:
Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter Comparison of Different Blade Types Using A.P. Advance, C-MAC System, and KingVision
Beteiligte:
Cavus, Erol;
Janssen, Sebastian;
Reifferscheid, Florian;
Caliebe, Amke;
Callies, Andreas;
von der Heyden, Martin;
Knacke, Peer G.;
Doerges, Volker
Beschreibung:
<jats:sec>
<jats:title>BACKGROUND:</jats:title>
<jats:p>Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>METHODS:</jats:title>
<jats:p>We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers. One hundred sixty-eight adult patients requiring prehospital emergency intubation were treated by an emergency physician and randomized to 1 of 3 portable videolaryngoscopes (A.P. Advance, C-MAC PM, and channeled blade KingVision) with different blade types. The primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices. <jats:italic toggle="yes">P</jats:italic> values for pairwise comparisons are corrected by the Bonferroni method for 3 tests (<jats:italic toggle="yes">P</jats:italic>[BF]). All presented <jats:italic toggle="yes">P</jats:italic> values are adjusted for center.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>RESULTS:</jats:title>
<jats:p>Glottis visualization was comparable with all 3 devices. Overall intubation success for A.P. Advance, C-MAC, and KingVision was 96%, 97%, and 61%, respectively (overall: <jats:italic toggle="yes">P</jats:italic> < .001, A.P. Advance versus C-MAC: odds ratio [OR], 0.97, 95% confidence interval [CI], 0.13–7.42, <jats:italic toggle="yes">P</jats:italic>[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.043, 95% CI, 0.0088–0.21, <jats:italic toggle="yes">P</jats:italic>[BF] < 0.001; C-MAC versus KingVision: OR, 0.043, 95% CI, 0.0088–0.21, <jats:italic toggle="yes">P</jats:italic>[BF] < 0.001). Intubation success on the first attempt with A.P. Advance, C-MAC, and KingVision was 86%, 85%, and 48%, respectively (overall: <jats:italic toggle="yes">P</jats:italic> < .001, A.P. Advance versus C-MAC: OR, 0.89, 95% CI, 0.31–2.53, <jats:italic toggle="yes">P</jats:italic>[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.24, 95% CI, 0.055–0.38, <jats:italic toggle="yes">P</jats:italic>[BF] = 0.0054; C-MAC versus KingVision: OR, 0.21, 95% CI, 0.043–.34, <jats:italic toggle="yes">P</jats:italic>[BF] < 0.003). Direct laryngoscopy for successful intubation with the videolaryngoscopic device was necessary with the A.P. Advance in 5 patients, and with the C-MAC in 4 patients. In the KingVision group, 21 patients were intubated with an alternative device.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>CONCLUSIONS:</jats:title>
<jats:p>During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.</jats:p>
</jats:sec>