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INTRODUCTION: Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight SL tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression. MATERIAL AND METHODS: We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view. RESULTS: The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = –11.29 [–13.10, –9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for DL (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08). CONCLUSIONS: Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

INTRODUCTION: The airway management and the implementation of optimal oxygen therapy in trauma patients, especially unconscious ones, is a key element of prehospital management. However, in cases of trauma lung or bronchial rupture, both lungs ventilation may not be advisable. In such cases, intubation with a double-lumen endotracheal tube may be helpful, allowing to provide one-lung ventilation. The aim of the experimental study was to assess the impact of short training in intubation using double-lumen tubes on the effectiveness of intubation performance and one-lung ventilation by paramedics in a simulated trauma patient setting. MATERIAL AND METHODS: This was a prospective, observational, randomized experimental trial. The study involved 30 paramedics. The participants had to perform tracheal intubation using Double Lumen Tube VivaSight-DL (VS-DL; ETView Ltd.; Misgav, Israel) under normal airway conditions. The effectiveness of the first intubation attempt, the time of intubation and the Cormack-Lehane scale were evaluated. RESULTS: The effectiveness of the first attempt at intubation with a double-lumen tube was 90% and the total effectiveness of intubation was 100%. The median time of the procedure was 63 (IQR; 38–72.5) seconds. CONCLUSIONS: In the simulation study, the paramedics were able to intubate using a double tube after a short training.

INTRODUCTION: The ability to perform endotracheal intubation is one of the basic skills that paramedics should demonstrate. However, in some cases where lung or bronchial injuries have occurred, it may be necessary to separate the lung by attaching a bronchial blocker and ventilating single lung. The aim of the study was to evaluate the effectiveness of bronchial protection with VivaSight-EB bronchial blocker tube and one-lung ventilation by paramedics in conditions of simulated lung injury. MATERIAL AND METHODS: The study was a prospective randomized cross-over simulation trial in which 27 paramedics took part. In the study, paramedics performed endotracheal intubation with ETView SL and then introduced a VivaSight-EB bronchial blocker and one-lung ventilation. The bronchial protection procedure took place in two scenarios: (A) normal airway; (B) difficult airway. VivaSight-EB bronchial blocker introduction time (T1) and one-lung ventilation time (T2) and the efficacy of the procedure were analysed. RESULTS: The efficacy of endotracheal intubation with ETView SL tube was 100% during both Scenario A and Scenario B. The efficacy of endotracheal intubation with ETView SL tube was 100%. The effectiveness of the first attempt to protect the bronchi with a bronchial blocker was 26% for both scenarios and the total effectiveness of bronchial protection was 100% in both cases. Time T1 for endotracheal intubation was 18sec for Scenario A (IQR; 16.5–25) and 20 sec for Scenario B (IQR; 17–25). The time to perform one-lung ventilation (Time T2) in scenarios A and B was 43 sec (IQR; 38–62.5) vs. 43.5 sec (38–65). CONCLUSIONS: The simulation study confirmed the research hypothesis that the paramedics were able to perform one-lung ventilation using the ETView-Blocker® bronchial blocker tube after a short training.

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

We hypothesized that the Airtraq laryngoscope (Airtraq LLC, Bonita Springs, Fla) is beneficial for intubation of pediatric manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the Macintosh (MAC) laryngoscope (HEINE Optotechnik, Munich, Germany) and Airtraq in 3 simulated CPR scenarios. A randomized crossover simulation trial was designed. Eighty-three nurses intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, Fla) using the MAC and Airtraq in a normal airway scenario, normal airway with chest compression scenario, and difficult airway with chest compression scenario. The participants were directed to perform a maximum of 3 attempts in each scenario. The success rate, time to intubation, Cormack & Lehane grade, dental compression, and the ease of intubation were measured. All participants performed successful intubation with the Airtraq in all 3 scenarios. In all scenarios, the success rate was significantly higher and the time to intubation was significantly shorter with the Airtraq than with the MAC. Glottic visualization using the Cormack-Lehane scale was also better when using Airtraq in all scenarios. In this manikin study, we found that the Airtraq can be used successfully for the intubation of pediatric manikins with normal and difficult airways by medical staff without previous experience in pediatric intubation. Moreover, intubation can be achieved without interrupting chest compression. The use of the Airtraq compared with the MAC led to faster time to intubation. Nevertheless, we recommend that the performance of the Airtraq and the MAC during CPR should be further evaluated in a clinical setting.

Backgroud Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR. Methods One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation. Results The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively. Conclusions Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.

Introduction We hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios. Methods A randomized crossover simulation trial was designed. One hundred seven paramedics intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) using the MAC and TMAC in a normal airway scenario (scenario A), normal airway with chest compression scenario (scenario B), and difficult airway with chest compression scenario (scenario C). The participants were directed to make a maximum of 3 attempts in each scenario. The success rate, time required for intubation, Cormack-Lehane grade, dental compression, and the ease of intubation were measured. Results The median time of intubation with MAC and TMAC in scenario A was 19.6 (interquartile range [IQR], 18-23) vs 19 (IQR, 16.2-21.8); in scenario B, 29.5 (IQR, 25-31) vs 26 (IQR, 23.5-29) seconds; and in scenario C, 38 (IQR, 32.5-45) vs 29 (IQR, 25-31) seconds, respectively. The overall efficacy for each of the scenarios was as follows: in scenario A, it was 100% vs 100%; in scenario B, it was 79.4% vs 100% (P = .007); and in scenario C, it was 68.2% vs 90.7% (P Conclusions The TMAC seems to be a superior intubating device compared with the conventional MAC when used in simulated normal and difficult child airway with chest compression scenarios. Future studies should explore the efficacy of TMAC in pediatric clinical emergency settings.

Introduction Endotracheal intubation is the gold standard of airway management during resuscitation. Purpose Comparison of efficacy of child intubation using Levitan stylet and laryngoscope with Miller blade during simulated normal and difficult airways during CPR. Material and methods In the study opened, randomized, crossover trial, 117 paramedics participated. They performed endotracheal intubation in two scenarios: normal and difficult airways during chest compression using two methods in randomized order. Results Endotracheal intubation using Levitan was associated with statistically better results than with the laryngoscope with Miller blade in both normal and difficult airways (p Conclusions During intubation in the laboratory simulation, paramedics performed intubation using the guide Levitan with higher efficiency and in less time than using a laryngoscope with Miller blade.

Deutschland GmbH, Grasbrunn, Germany). The bougie is a 60-cm guide with a curved end and depth markers (OR 15 Ch), which was designed to assist in tracheal tube exchange during difficult intubation. This study was a randomized crossover manikin trial. Each participant attempted the exchange in scenarios with and without chest compression, and the order of scenarios and the participants was randomized using a computer-generated randomized sequence (www. researchrandomizer.com; Fig. 2: Supplementary data). The survey was conducted in March 2015 and was attended by 75 paramedics who exchanged an LT (size 4; VBM Medizintechnik GmbH) for an ETT (ID 7.5; Smiths Medical Deutschland GmbH) in the 2 aforementioned scenarios. The procedures were performed on a METIman Prehospital manikin (CAE HealthCare, Saint-Laurent, Quebec, Canada). Chest compression was performed using a LUCAS-2 (Physio-Control, Redmond, WA). The tube exchange timewas defined as the time from the participant picking up the introducer to ventilation of themanikin's lungs. A procedure was determined to have failed when the time taken to insert an ETT exceeded 120 seconds. Results are shown as median and interquartile range (IQR) and absolute numbers and percentages (%). Statistical analysiswas performed using Statistica version 12 forWindows (StatSoft, Inc, Tulusa, OK). P b .05 was considered as statistically significant. Times needed to successful intubation were compared using the Wilcoxon signed rank test. There were no significant differences in the LT exchange effectiveness in scenarios with and without chest compression (P = .89; Table). Of the 75 participants, 2 failed the LT exchange in the scenario without chest compression, and 4 failed in the scenario with chest compression. Median time to LT exchange in both scenarios varied: 59.3 seconds (IQR, 35.7-68.3 seconds) vs 64.9 seconds (IQR, 41.481.3 seconds). We conclude that LT exchange using the bougie intubation stylet may be useful in the rapid intubation of patients during CPR. Using the bougie for LT exchange seems to be faster than using a fiberscope, as indicated in the study by Budde et al [1]. More studies are required to confirm these results. Figure. View of the glottic opening through the LT-D. Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ajem.2015.04.049.

Background. Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians. Methods. This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed. Results. All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy. Conclusion. The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT02733536.