Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?: A Randomized Crossover Manikin Study.
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SUBMITTER: Kurowski A
PROVIDER: S-EPMC4616410 | BioStudies | 2015-01-01
REPOSITORIES: biostudies
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Project description: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.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.clinicaltrials.gov Identifier: NCT02289872.•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.
2015-01-01 | S-EPMC4575358 | BioStudies
Project description:Objective: To compare a novel two-thumb chest compression technique with standard techniques during newborn resuscitation performed by novice physicians in terms of median depth of chest compressions, degree of full chest recoil, and effective compression efficacy. Patients and Methods: The total of 74 novice physicians with less than 1-year work experience participated in the study. They performed chest compressions using three techniques: (A) The new two-thumb technique (nTTT). The novel method of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. (B) TFT. With this method, the rescuer compresses the sternum with the tips of two fingers. (C) TTHT. Two thumbs are placed over the lower third of the sternum, with the fingers encircling the torso and supporting the back. Results: The median depth of chest compressions for nTTT was 3.8 (IQR, 3.7-3.9) cm, for TFT-2.1 (IQR, 1.7-2.5) cm, while for TTHT-3.6 (IQR, 3.5-3.8) cm. There was a significant difference between nTTT and TFT, and TTHT and TFT (p < 0.001) for each time interval during resuscitation. The degree of full chest recoil was 93% (IQR, 91-97) for nTTT, 99% (IQR, 96-100) for TFT, and 90% (IQR, 74-91) for TTHT. There was a statistically significant difference in the degree of complete chest relaxation between nTTT and TFT (p < 0.001), between nTTT and TTHT (p = 0.016), and between TFT and TTHT (p < 0.001). Conclusion: The median chest compression depth for nTTT and TTHT is significantly higher than that for TFT. The degree of full chest recoil was highest for TFT, then for nTTT and TTHT. The effective compression efficiency with nTTT was higher than for TTHT and TFT. Our novel newborn chest compression method in this manikin study provided adequate chest compression depth and degree of full chest recoil, as well as very good effective compression efficiency. Further clinical studies are necessary to confirm these initial results.
2018-01-01 | S-EPMC5986950 | BioStudies
Project description:<h4>Introduction</h4>Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study.<h4>Methods</h4>Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary.<h4>Results</h4>The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group.<h4>Conclusion</h4>As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.
2016-01-01 | S-EPMC4873178 | BioStudies
Project description:<h4>Background</h4>Endotracheal intubation (ETI) can be challenging, especially in life-threatening situations such as cardiopulmonary resuscitation (CPR). Videolaryngoscopes aim to ease ETI, but effort is still widely discussed. This study intended to investigate 2 different airway devices regarding the success rate of ETI during ongoing chest compressions.<h4>Methods</h4>This randomized, cross-over, multi-center manikin trial included 85 experienced paramedics actively working in the emergency medicine service. After a standardized training session, all paramedics underwent 3 airway scenarios using both, direct laryngoscopy using a Macintosh blade and videolaryngoscope (the UEScope): normal airway without chest compressions, normal airway with uninterrupted chest compressions, and difficult airway with uninterrupted chest compressions. The primary outcome was successful ETI, defined as successful placement of the endotracheal tube within the manikin's trachea. Secondary outcomes were number of intubation attempts, time to successful ETI, time to best glottis view, best percent of glottic opening, best glottic view score (Cormack and Lehane), occurrence of dental trauma, ease of use, and willing to reuse in real-life situations.<h4>Results</h4>The UEScope provided a better glottis visualization, and higher first pass intubation success rate compared to direct laryngoscopy in all 3 scenarios. The overall intubation success was higher, and the intubation time was shorter with the UEScope in scenario B and scenario C, but was comparable in scenario A. Dental compression occurred less often using the UEScope and paramedics rated intubation using the UEScope easier compared to direct laryngoscopy in all 3 airway scenarios.<h4>Conclusion</h4>In simulated CPR scenarios, intubation with the UEScope resulted in a better glottis visualization, a higher intubation success, and a shorter intubation time compared to Macintosh laryngoscope (MAC). Moreover, in situations where the airway is difficult for ETI especially by the paramedic, the UEScope would be a better choice than the MAC. Further studies are needed to confirm these results in real-life patients.
2018-01-01 | S-EPMC6133438 | BioStudies
Project description:Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR.ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario.The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p?=?.013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p?<?.001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT.In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion, and cuff block were all found to be shorter with the ETView.clinicaltrials.gov Identifier: NCT02733536.
2016-01-01 | S-EPMC5591099 | BioStudies
Project description:BACKGROUND:Quality of cardiopulmonary resuscitation (CPR) is key to increase survival from cardiac arrest. Providing chest compressions with adequate rate and depth is difficult even for well-trained rescuers. The use of real-time feedback devices is intended to contribute to enhance chest compression quality. These devices are typically based on the double integration of the acceleration to obtain the chest displacement during compressions. The integration process is inherently unstable and leads to important errors unless boundary conditions are applied for each compression cycle. Commercial solutions use additional reference signals to establish these conditions, requiring additional sensors. Our aim was to study the accuracy of three methods based solely on the acceleration signal to provide feedback on the compression rate and depth. MATERIALS AND METHODS:We simulated a CPR scenario with several volunteers grouped in couples providing chest compressions on a resuscitation manikin. Different target rates (80, 100, 120, and 140 compressions per minute) and a target depth of at least 50 mm were indicated. The manikin was equipped with a displacement sensor. The accelerometer was placed between the rescuer's hands and the manikin's chest. We designed three alternatives to direct integration based on different principles (linear filtering, analysis of velocity, and spectral analysis of acceleration). We evaluated their accuracy by comparing the estimated depth and rate with the values obtained from the reference displacement sensor. RESULTS:The median (IQR) percent error was 5.9% (2.8-10.3), 6.3% (2.9-11.3), and 2.5% (1.2-4.4) for depth and 1.7% (0.0-2.3), 0.0% (0.0-2.0), and 0.9% (0.4-1.6) for rate, respectively. Depth accuracy depended on the target rate (p < 0.001) and on the rescuer couple (p < 0.001) within each method. CONCLUSIONS:Accurate feedback on chest compression depth and rate during CPR is possible using exclusively the chest acceleration signal. The algorithm based on spectral analysis showed the best performance. Despite these encouraging results, further research should be conducted to asses the performance of these algorithms with clinical data.
2016-01-01 | S-EPMC4773040 | BioStudies
Project description:BACKGROUND AND OBJECTIVE:Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. METHODS:Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to "push as hard as you can" in the simplified protocol, compared to "push down firmly 2in. (5cm)" in MPDS. Data were recorded via a Laerdal ResusciAnne SkillReporter manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. RESULTS:Instructions to "push as hard as you can", compared to "push down firmly 2in. (5cm)", resulted in improved chest compression depth (36.4 mm vs. 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs. <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 min(-1) vs. 97.5 min(-1), p<0.56) was found. CONCLUSIONS:Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.
2008-01-01 | S-EPMC2614464 | BioStudies
Project description:High-quality chest compressions are pivotal to improve survival from cardiac arrest. Basic life support training of school students is an international priority. The aim of this trial was to assess the effectiveness of a real-time training software (Laerdal QCPR®) compared to a standard instructor-based feedback for chest compressions acquisition in secondary school students. After an interactive frontal lesson about basic life support and high quality chest compressions, 144 students were randomized to two types of chest compressions training: 1) using Laerdal QCPR® (QCPR group- 72 students) for real-time feedback during chest compressions with the guide of an instructor who considered software data for students' correction 2) based on standard instructor-based feedback (SF group- 72 students). Both groups had a minimum of a 2-minute chest compressions training session. Students were required to reach a minimum technical skill level before the evaluation. We evaluated all students at 7 days from the training with a 2-minute chest compressions session. The primary outcome was the compression score, which is an overall measure of chest compressions quality calculated by the software expressed as percentage. 125 students were present at the evaluation session (60 from QCPR group and 65 from SF group). Students in QCPR group had a significantly higher compression score (median 90%, IQR 81.9-96.0) compared to SF group (median 67%, IQR 27.7-87.5), p = 0.0003. Students in QCPR group performed significantly higher percentage of fully released chest compressions (71% [IQR 24.5-99.0] vs 24% [IQR 2.5-88.2]; p = 0.005) and better chest compression rate (117.5/min [IQR 106-123.5] vs 125/min [115-135.2]; p = 0.001). In secondary school students, a training for chest compressions based on a real-time feedback software (Laerdal QCPR®) guided by an instructor is superior to instructor-based feedback training in terms of chest compression technical skill acquisition.Australian New Zealand Clinical Trials Registry ACTRN12616000383460.
2017-01-01 | S-EPMC5215847 | BioStudies
Project description:We developed a new chest compression depth (CCD) measuring technology using radar and impulse-radio ultra-wideband (IR-UWB) sensor. This study was performed to determine its accuracy on a soft surface.Four trials, trial 1: chest compressions on the floor using an accelerometer device; trial 2: chest compressions on the floor using an IR-UWB sensor; trial 3: chest compressions on a foam mattress using an accelerometer device; trial 4: chest compressions on a foam mattress using an IR-UWB sensor, were performed in a random order. In all the trials, a cardiopulmonary resuscitation provider delivered 50 uninterrupted chest compressions to a manikin.The CCD measured by the manikin and the device were as follows: 57.42 ± 2.23 and 53.92 ± 2.92 mm, respectively in trial 1 (p < 0.001); 56.29 ± 1.96 and 54.16 ± 3.90 mm, respectively in trial 2 (p < 0.001); 55.61 ± 1.57 and 103.48 ± 10.48 mm, respectively in trial 3 (p < 0.001); 57.14 ± 3.99 and 55.51 ± 3.39 mm, respectively in trial 4 (p = 0.012). The gaps between the CCD measured by the manikin and the devices (accelerometer device vs. IR-UWB sensor) on the floor were not different (3.50 ± 2.08 mm vs. 3.15 ± 2.27 mm, respectively, p = 0.136). However, the gaps were significantly different on the foam mattress (48.53 ± 5.65 mm vs. 4.10 ± 2.47 mm, p < 0.001).The IR-UWB sensor could measure the CCD accurately both on the floor and on the foam mattress.
2017-01-01 | S-EPMC5576690 | BioStudies
Project description:<h4>Background</h4>The 2005 Emergency Cardiac Care guidelines for basic life support (BLS) recommend compression to ventilation ratio of 30:2. The effect of the additional exertion required to deliver more chest compressions may present a considerable physical burden on the provider.<h4>Objective</h4>To compare cardiopulmonary resuscitation (CPR) performance and perceived exertion during compression to ventilation ratios of 15:2 and 30:2 with real-time feedback during two-rescuer CPR.<h4>Methods</h4>Eighteen BLS-certified healthcare providers each performed 5 min of chest compressions on a manikin with compression to ventilation ratios of 15:2 or 30:2 on two separate sessions. Heart rate, capillary lactate, and OMNI rate of perceived exertion (RPE) were recorded before and after each session. Subjects were given continuous, automated, feedback via an accelerometer that measured rate, depth, duration, and release of compressions. Compression measurements and feedback messages were recorded continuously during each 5-min session. Data were analyzed using descriptive statistics and t-test to compare groups. Repeated measures ANOVA were used to compare data over the 5-min epoch.<h4>Results</h4>After performing external chest compressions for 5 min, peak heart rate (102+/-24 vs. 106+/-27), capillary lactate (2.2+/-0.95 vs. 2.2+/-0.96), and OMNI RPE (4.3+/-1.2 vs. 4.6+/-1.1) were higher were higher than baseline, but did not differ between 15:2 and 30:2. Compression rate (102+/-24 vs.106+/-27) and depth (38.8+/-3.6 vs. 38.2+/-2.9) did not differ between 15:2 and 30:2 groups or at any minute. Total chest compressions delivered were higher (p<0.05) in the 30:2 group (457+/-43) compared to 15:2 (379+/-28). The average no flow time was lower (p<0.05) in the 30:2 group (22+/-3.03) compared to the 15:2 group (33+/-2.64). Number of correction prompts (48+/-55 vs. 64+/-70) did not differ significantly between the 15:2 and 30:2 groups.<h4>Conclusions</h4>In a cohort of healthcare providers, increasing the CPR ratio from 15:2 to 30:2 did not change physical or perceived exertion during a 5-min bout of CPR when continuous, real-time feedback is provided. The 30:2 compression to ventilation ratio resulted in more chest compressions per minute without decreasing CPR quality.
2008-01-01 | S-EPMC2613429 | BioStudies