Efficacy of the Disposcope endoscope, a new video laryngoscope, for endotracheal intubation in patients with cervical spine immobilisation by semirigid neck collar: comparison with the Macintosh laryngoscope using a simulation study on a manikin.
ABSTRACT OBJECTIVE: To evaluate whether endotracheal intubation in patients with cervical spine immobilisation by a semirigid neck collar is easier using the Disposcope endoscope (DE), a new video laryngoscope, than with the Macintosh laryngoscope (ML). METHODS: Sixty-eight medical interns who participated in a training programme for endotracheal intubation using the DE and ML were recruited to the randomised crossover trial 1 week after completing the training programme. In the trial, they used both the DE and the ML to perform intubation on a manikin wearing a semirigid neck collar. The time required to view the vocal cords and to complete intubation, successful endotracheal intubation, modified Cormack-Lehane classification (CL grade) and dental injury were recorded and analysed. RESULTS: The mean (SD) time to view the vocal cords was significantly shorter with the DE than with the ML (10.0 (7.0) vs 20.8 (18.9) s; p<0.0001). There were higher rates of CL grades 1 and 2a (69.1% and 22.1%) using the DE than with the ML (10.3% and 14.7%). All 68 participants had a higher rate of successful endotracheal intubation using the DE than using the ML (68 (100%) vs 47 (69.1%); p<0.0001). It took less time to complete endotracheal intubation with the DE than with the ML (p<0.0001). CONCLUSIONS: In patients with cervical spine immobilisation by a semirigid neck collar, the DE may be a more effective device for endotracheal intubation than the ML.
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ABSTRACT: Endotracheal intubation is a common procedure in the emergency department, and new devices may improve intubation time, success, or view. We compared the King Vision video laryngoscope (KVVL; King Systems, Noblesville, IN) to the Macintosh direct laryngoscope (DL) in simulated normal and difficult airways. Using manikins and clinical-grade cadavers, difficult airway scenarios were simulated using head movement restriction or a cervical spine collar. Four scenarios were studied using the KVVL and DL: normal manikin airway, difficult manikin airway, normal cadaver airway, and difficult cadaver airway. Primary outcomes were time to intubation and rate of successful intubation. Secondary outcomes were the percent of glottic opening and Cormack-Lehane grade visualized. Thirty-two paramedics participated in the study. In the normal manikin airway scenario, time to intubation was 3.4 s (99% confidence interval [CI] 0.1-6.6) faster with the KVVL compared with DL. Time to intubation was 11.3 s (99% CI 2.4-20.2) faster with the KVVL in the difficult cadaver airway scenario. There was no difference in time to intubation in the other 2 scenarios. In the difficult cadaver airway, 10 of 32 participants failed to successfully intubate the trachea using DL, whereas all KVVL intubations were successful. All scenarios found a lower Cormack-Lehane grade and higher percentage of glottic opening with the KVVL compared to DL. The KVVL was slightly faster than Macintosh DL in two of four studied airway scenarios, and had a higher success rate in the difficult cadaver airway scenario. Further study is required in the clinical setting.Journal of Emergency Medicine 04/2014; · 1.33 Impact Factor