A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan

Abstract

Background
In Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope.

Objective
The purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients.

Method
This study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2.

Results
A total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01–1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03–1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups.

Conclusion
Our data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.

Full text

Clinical paper
A comparative study of Video laryngoscope vs
Macintosh laryngoscope for prehospital tracheal
intubation in Hiroshima, Japan
N. Santou
a,*
, H. Ueta
a
, K. Nakagawa
b
, K. Hata
b,e
, S. Kusunoki
c
, T. Sadamori
d
,
H. Takyu
b
, H. Tanaka
a,b
Abstract
Background: In Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-
hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope.
Objective: The purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological
prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients.
Method: This study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical trans-
port data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the inci-
dence of ROSC and CPC1-2.
Results: A total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and
89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01–1.10, P= 0.01), the VL group shows significantly higher success rate than that of the ML
group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating
significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03–1.09, P< 0.001). The ROSC rate and
CPC1-2 rate are similar among the groups.
Conclusion: Our data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is
necessary for the future development of Emergency Medical Services (EMS) intubation devices.
Keywords: Video laryngoscope, OHCA, Prehospital tracheal intubation, ROSC rate, CPC1-2, EMS, EMT, Medical Control
Introduction
In Japan, EMTs have been allowed tracheal intubation in out-of-
hospital cardiac arrest (OHCA) patients since 2004. Yet, in recent
years, its efficacy has been controversial.
Benoit et al.
2
reported that the odds ratio for ROSC was signifi-
cantly higher in OHCA patients who received tracheal intubation than
in OHCA patients received supraglottic airway devices, indicating the
benefit of tracheal intubation. Hirasawa
3
also compared the survival
rates of OHCA patients with supraglottic airway devices and intu-
bated patients, and summarized that tracheal intubation worsening
survival rate of OHCA and that there is no medical evidence that tra-
cheal intubation contributes to improved survival in OHCA. Further-
more, some studies indicate better survival-discharge rates and
neurological outcomes with mask ventilation than with tracheal intu-
bation,
4
Hasegawa et al.
5
In this context, CoSTR2020 proposes the use of supraglottic air-
way devices or tracheal intubation for advanced airway clearance in
emergency systems with a high success rate of tracheal intubation in
OHCA, and the use of supraglottic airway devices for advanced air-
way clearance in emergency systems with a low success rate of tra-
cheal intubation.
1
In Japan, a demonstration study was conducted in Hiroshima
Prefecture in 2010, and the effectiveness and safety of VL use by
https://doi.org/10.1016/j.resplu.2022.100340
Received 29 September 2022; Received in revised form 16 November 2022; Accepted 28 November 2022
2666-5204/Ó2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/).
* Corresponding author at: Research Institute of Disaster Management and EMS, Kokushikan University, 7-3-1, Nagayama, Tama city, Tokyo 205-
8515, Japan.
E-mail address: nobuos@kokushikan.ac.jp (N. Santou).
RESUSCITATION PLUS13 (2023) 100340
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journal homepage: www.elsevier.com/locate/resuscitation-plus

EMTs for patients scheduled for surgery were confirmed (success
rate: 97%).
6
Based on these results, tracheal intubation using a VL has been
available since August 2011, and certified VL EMTs have been
trained since 2012.
7
However, the status of training and tracheal
intubation protocols differ among prefectural Medical control commit-
tees, which is reported to be related to regional disparities in hospital
practice, medical resources, and operability compared to conven-
tional laryngoscopes.
8
Comparative studies of tracheal intubation with ML and VL
include a study report by a physician at a medical institution
9
and
a study report by a mannequin.
10
However, comp parative studies
by prehospital EMTs have been reported in the United States
11
and Europe,
12
but not in Japan.
Therefore, we have been using a Video laryngoscope (Airway
Scope
Ò
) as the first choice device for tracheal intubation since
2012, and analyzed data from Hiroshima Prefecture, which has a
high rate of Video laryngoscope use, and in OHCA patients, we
hypothesized that tracheal intubation with a Video laryngoscope
would improve the prognosis of the injured patient.
Objective
The purpose of this study was to compare the success rate, compli-
cation rate, ROSC rate, CPC1-2, and regional differences between
Video laryngoscope (VL) and Macintosh laryngoscope (ML) and to
examine the usefulness of VL.
Method
Study design
In this retrospective cohort study, we extracted data on tracheal
intubation in Hiroshima Prefecture from the Utstein style data
nationwide from 2015 to 2019, and added emergency transport
data and Hiroshima Prefecture tracheal intubation verification form
data.
In conducting this study, we applied to the “Ethics Committee on
Research Involving Human Subjects” of Kokushikan University and
obtained their approval (receipt number 21005). The parties involved
in the facilities providing the materials in Hiroshima Prefecture were
fully informed and their consent was obtained in writing. The data
used in this study did not contain any data that would identify the
names of facilities or individuals, and we took sufficient care to pro-
tect the privacy of the data.
Target and extraction conditions
For the extraction of data used in this study, we combined 5 years of
nationwide Utstein style data (627,982 cases) and emergency trans-
port data (26,710,481 cases) collected from January 1, 2015 to
December 31, 2019, from which we extracted cases of OHCA occur-
rence in Hiroshima Prefecture (10,067 cases). We combined the
OHCA cases in Hiroshima Prefecture (10,067 cases) with data from
the Hiroshima Prefecture tracheal intubation verification form (1062
cases), and extracted 979 cases, excluding 83 cases that were not
combined. From the extracted 979 cases of tracheal intubation in Hir-
oshima Prefecture (979 cases), (1) cases with negative values for
time factor (31 cases), (2) cases with outliers for time factor (58
cases), and (3) cases with multiple identical cases (5 cases) were
excluded. The above items were excluded, and 885 cases were
included in this study (Figure 1).
The Medical Control system in Hiroshima Prefecture, the target
prefecture, as of April 1, 2019, consists of 7 regional medical control
committees, 13 fire departments. There are 633 EMTs who are oper-
ational. There are 228 EMTs certified in tracheal intubation and 170
EMTs certified in Video laryngoscopy, and 405 EMTs (64% of the
total) are not certified in tracheal intubation. Advanced airway secur-
ing devices include a supraglottic airway device (Laryngeal Mask,
Laryngeal Tube) and a tracheal intubation tube. Paramedics without
tracheal intubation certification (64%) use supraglottic airway
devices, and EMTs certified in tracheal intubation (36%) use a tra-
cheal intubation tube, attempt tracheal intubation, and use a supra-
glottic airway device if they find it difficult.
Study endpoint
Primary outcomes were success rate of tracheal intubation and com-
plication rate (oesophageal intubation), and secondary outcomes
were ROSC rate and CPC1-2. The good neurological prognosis rate
at 1 month was defined as CPC1: good function and CPC2: moder-
ate impairment in the Glasgow- Pittsburgh Cerebral Performance
Category. The success rate of tracheal intubation and the number
of tracheal intubations performed (per 1 million population) were
compared in each region of Hiroshima Prefecture.
Statistical analysis
Numerical data were expressed as mean (standard deviation; SD).
Student’s t-test for comparison of continuous variables between
each group. Qualitative data measures are presented in % (number
of cases). Pearson’s chi-square test and Fisher’s exact test were
used for comparison, with a significance level of 5%, and relative risk
(RR) and 95% confidence interval (CI) were estimated. Microsoft
Excel 2019 and JMP Pro15 were used for statistical analysis.
Results
Patients background
The background of the injured and ill patients studied is shown in
Table 1.
Age, gender, bystander chest compressions, bystander AED,
waveform type, electroshock, and medication administration were
validated. There was a significant difference between groups in the
presence or absence of bystander chest compressions (P= 0.035).
In terms of initial ECG waveform type, Asystole accounted for the
highest percentage in both groups: 70.8% (369/521) in the Video
group and 71.4% (260/364) in the ML group.
Results of success rates and complication
rates and time to perform tracheal intubation.
A total of 885 tracheal intubated OHCA were enrolled in this study.
The success rate was 94.1%(490/521) in the VL group and 89.3%
(325/364) in the ML group(RR, 1.05;95%CI, 1.01–1.10, P= 0.01).
The first time success rate was 87.7% (457/521) in the VL group
and 81.6% (297/364) in the ML group (RR, 1.07; 95%CI, 1.01–
1.14, P= 0.01), In the VL group shows significantly higher success
rate than that of the ML group. In the complication rates, oesopha-
geal intubation occurred in 0.2% (1/521) of in the VL group and in
2RESUSCITATION PLUS 13 (2023) 100340

6.0% (22/364) in the ML group, Indicating significantly higher compli-
cation rates in the ML group compared with the VL group (RR, 1.06;
95%CI, 1.03–1.09, P< 0.001). The mean time from contact with the
injured person to completion of tracheal intubation was 13.4 (±5.4)
minutes in the VL group and 14.0 (±6.0) minutes in the ML group,
and the mean time from contact with the injured person to hospital
admission was 28.2 (±8.6) minutes in the VL group and 28.6
(±9.1) minutes in the ML group, with no significant difference
(Table 2).
Comparative results of where tracheal intubation was
performed
Regarding the comparison of the location where tracheal intubation
was performed, the cases where it was performed in the field were
significantly higher in the VL group than in the ML group, 58.2%
(303/521) in the VL group and 50.8% (185/364) in the ML group
(RR, 1.14; 95%CI, 1.01–1.30, P= 0.03). The success rate in the field
was 95.0% (288/303) in the VL group and 88.7% (164/185) in the ML
group, which was significantly higher in the VL group than in the ML
group (RR, 1.07; 95%CI, 1.01–1.13, P= 0.01). The success rate
after field departure from the field was 92.7% (202/218) in the VL
group and 89.9% (161/179) in the ML group (RR, 1.03; 95%CI,
0.97–1.10, P= 0.34). When we compared the percentage of ROSC
cases in which tracheal intubation was performed in the field, 77.8%
(21/27) in the VL group and 66.7% (12/18) in the ML group, with no
significant difference between the groups (RR, 1.17; 95% CI, 0.79–
1.71, P= 0.41). Among the CPC1-2 cases, the percentage of tra-
cheal intubation performed in the field was 100% (8/8) in the VL
group and 60.0% (3/5) in the ML group, with no significant difference
between the groups (RR, 1.67; 95% CI, 0.84–3.41, P= 0.13)
(Table 2).
ROSC rate and CPC1-2 results
The ROSC rate in all cases with tracheal intubation was 5.5%
(27/490) in the VL group and 5.5% (18/325) in the ML group, with
no significant difference between the groups (RR, 0.99; 95%CI,
0.57–1.78, P= 0.99). Similarly, CPC1-2 in tracheal intubation cases
was 1.6% (8/490) in VL group and 1.5% (5/325) in ML group with no
significant difference between the two groups (RR, 1.06; 95%CI,
0.35–3.22, P= 0.91) (Table 3).
Table1 – Patients background.
Laryngoscope used Video laryngoscope (n = 521) Macintosh laryngoscope (n = 364) P-value
Age, mean (SD), years 77.9 (13.8) 78.2 (13.3) 0.79
Gender, No. (%) 290 (55.7) 200 (54.9) 0.83
Bystander CPR, No. (%) 253 (57.0) 167 (49.4) 0.0350
Bystander AED, No. (%) 8 (2.1) 3 (0.9) 0.24
Initial ECG, No. (%)
VF 18 (3.5) 16 (4.4) 0.45
VT 4 (0.77) 0 (0)
PEA 126 (24.2) 87 (23.9)
Asystole 369 (70.8) 260 (71.4)
Defibrillation, No. (%) 30 (7.7) 33 (9.7) 0.34
Epinephrine administration (%) 105 (25.5) 67 (19.9) 0.07
CPR: cardiopulmonary resuscitation, AED: Automated external defibrillator, ECG: electro cardiogram, VF: ventricular fibrillation, VT: ventricular tachycardia, PEA:
pulseless electrical activity, SD: standard deviation.
Table 2 – Success rate and complication rate.
Video
laryngoscope
Macintosh
laryngoscope
P-value RR (95%CI)
Success rate 94.1% (490/521) 89.3% (325/364) 0.01 1.05 (1.01–1.10)
First time success rate 87.7% (457/521) 81.6% (297/364) 0.01 1.07 (1.01–1.14)
Time from casualty contact to completion of tracheal
intubation. mean (SD).min
13.4 (5.4) 14.0 (6.0) 0.15
Contact to completion of hospital Arrival
Time. mean (SD).min
28.2 (8.6) 28.6 (9.1) 0.47
Complication rate
Incidence of oesophageal intubation 0.2% (1/521) 6.0% (22/364) <0.001 1.06 (1.03–1.09)
Tooth damage 0.2% (1/521) 0.3% (1/364)
Percentage of on-site implementation 58.2% (303/521) 50.8% (185/364) 0.03 1.14 (1.01–1.30)
Success rate 95.0% (288/303) 88.7% (164/185) 0.01 1.07 (1.01–1.13)
Success rate after field departure 92.7% (202/218) 89.9% (161/179) 0.34 1.03 (0.97–1.10)
Successful tracheal intubation rate, tracheal intubation implementation rate, complication rate are expressed as % and (real numbers).
(): The left side is the number of successes ・implementations / total number.
Group comparisons were made using the Pearson’s chi-square test and Fisher’s exact test to estimate RR and 95% CI.
Intubation time values are expressed as mean (standard deviation), and two-sample t-tests assuming equal variances were used to compare groups.
RESUSCITATION PLUS 13 (2023) 100340 3

Successful intubation rate and number of intubations
performed by each region
The success rate of tracheal intubation in Hiroshima Prefecture was
92.0% (815/885). Success rates were 100% (35/35) in HA, 97.2%
(104/107) in HB, 93.1% (335/360) in HC, 92.1% (210/228) in HD,
87.7% (121/138) in HE and 58.8% (10/17) in HF, regional differences
were found. The number of patients intubated per million population
was 244 in the HA region, 1227 in the HB region, 1394 in the HC
region, 153 in the HD region, 508 in the HE region, and 20 in the
HF region, indicating a disparity in the number of tracheal intubations
performed for OHCA in each MC region. As for the comparison of the
success rates between the VL and ML groups, each area showed the
same success rate between the groups or a higher success rate in
the VL group (Table 4).
Discussion
Discussion of the main results of this study
In the present study, the success rate of tracheal intubation and the
incidence of oesophageal intubation were examined using OHCA data
from Hiroshima Prefecture, suggesting the usefulness of VL. At pre-
sent, the process for obtaining VL certification in Japan is as follows
the Medical control committees first grants ML certification to those
who successfully complete 30 cases of tracheal intubation in hospital
practice, and then grants VL certification to those who successfully
complete 5 cases of VL. Thus, it cannot be denied that VL may have
had a higher success rate than ML because the person who performed
tracheal intubation in VL was a paramedic with sufficient experience in
performing tracheal intubation in ML. On the other hand, the EMTs who
performed the ML were inexperienced in tracheal intubation, which
may have contributed to the lower success rate.
Previous studies on tracheal intubation in OHCA have reported
similar or conflicting results to the present study. Risse et al.
11
reported on a study conducted on German paramedics and found
that there was no significant difference in the success rate compar-
ison between VL (Glidescope
Ò
) and direct viewing laryngoscope
(75% and 68.1%, respectively) (P= 0.63). In addition, Huebinger
et al.
12
reported a study conducted on paramedics in the United
States and found that there was a significant difference in the suc-
cess rate between VL (80.8%) and direct viewing laryngoscope
(73.1%) (95% CI6.4%-9.0%, P< 0.001) and that the increased
ROSC rate was not related to the use of VL (aOR 1.0, 95% CI
0.9–1.1).
In Hiroshima Prefecture, the Ministry of Health, Labor, and Wel-
fare has notified the Ministry that five successful cases of hospital
training are required as prior training for VL certification, and that
after certification, re-training at a hospital is conducted every-two
to three years. In addition, since the protocol specifies VL as the first
choice device for tracheal intubation, many EMTs have experience in
performing tracheal intubation with VL, which may be one of the rea-
sons for the higher success rate compared to previous studies.
In addition, the Video laryngoscope makes it relatively easy to
see the larynx and insert the tube even during chest compressions,
and the monitor allows multiple people to check the tube, which is
thought to be one reason for the low incidence of esophageal intuba-
tion and the high success rate. Esophageal intubation is fatal, and in
this study, esophageal intubation was greatly reduced in the VL
group compared to the ML group. Timmermann et al.
13
reported that
emergency physicians performed tracheal intubation in 149 OHCA
cases and esophageal intubation was observed in 10 cases
(6.7%). Since esophageal intubation may occur with a certain fre-
quency even if a physician performs tracheal intubation in OHCA,
we would assume that the incidence of esophageal intubation is also
higher when EMTs perform tracheal intubation in OHCA.
There are currently no precise values or definitions to distinguish
between high and low success rates of tracheal intubation for OHCA;
the studies by Wang et al.
14
and Benger et al.
15
considered the suc-
cess rate of tracheal intubation to be low (51.6% and 69.8%, respec-
tively), while the study by Jabre et al.
16
judged the success rate of
tracheal intubation to be high (97.9%). The success rate of VL in this
study was 94.0%, and that of ML was 89.8%. We believe that both
can be judged as having a high success rate for tracheal intubation.
The JRC (Japan Resuscitation Council) Resuscitation Guidelines
2020 also states that validation based on regional tracheal intubation
success rates (and the need for uniform definitions) is necessary in
order to recommend which advanced airway securing devices to
use
1
.
Consideration of the timing of tracheal intubation
The timing of tracheal intubation for OHCA has been much debated,
and CoSTR2020 points out that in addition to the airway maneuver,
the timing of the maneuver is also important, as observational stud-
ies have shown that advanced airway securement is associated with
poor neurological outcomes and decreased survival if the timing is
delayed.
1
Kajino et al.
17
and Nakagawa et al.
18
reported that the later the
paramedic tracheal intuba tion, the worse the prognosis, and early
tracheal intubation correlated with a favorable neurological outcome,
respectively.
In this study, approximately 60% of the VL group and 50% of the
ML group were performed early on prior to ambulance admission,
Table 3 – ROSC rate, CPC1-2.
Video laryngoscope Macintosh laryngoscope P-value RR (95%CI)
Percentage of ROSC cases intubated in the field 77.8% (21/27) 66.7% (12/18) 0.41 1.17(0.79–1.71)
Percentage of CPC 1–2 cases intubated in the field 100% (8/8) 60.0% (3/5) 0.13 1.67(0.84–3.41)
ROSC rate 5.5% (27/490) 5.5% (18/325) 0.99 0.99(0.57–1.78)
CPC1-2 1.6% (8/490) 1.5% (5/325) 0.91 1.06(0.35–3.22)
ROSC:return of spontaneous circulation. CPC:cerebral performance category.
ROSC rate and CPC1-2 are expressed as % and (real numbers).
(): The left side is the number of successes ・implementations / total number.
Group comparisons were made using the Pearson’s chi-square test and Fisher’s exact test to estimate RR and 95% CI.
4RESUSCITATION PLUS 13 (2023) 100340

and the ROSC rate for these early cases was 77.8% for the VL group
and 100% for CPC1-2. It was found that performing tracheal intuba-
tion at the scene before in-vehicle housing increased both the ROSC
rate and CPC1-2 rate. The reason for this was that after tracheal
intubation, high quality chest compressions could be continued with
minimal interruption of chest compressions.
Furthermore, a comparative of the results of tracheal intubation
performed in the field showed that the success rate was 95.0% for
the VL group and 88.7% for the ML group, with the VL group having
a significantly higher success rate than the ML group. The ROSC
rate,CPC1-2 relationship also suggested the usefulness of VL.
Successful intubation rate and number of intubations
performed by each region
The success rates of the VL group and the ML group were 94.1%
and 89.3%, respectively. However, when comparing the success
rate and number of tracheal intubations performed in each region,
the success rate of tracheal intubation varied from 58.8% to 100%.
In terms of the number of tracheal intubations attempted per million
population, there was a large disparity in the number of tracheal intu-
bations performed for OHCA in each region, ranging from 33 to 1498.
Success rates were also extremely low in areas where the number of
intubations performed per million population was extremely low. One
of the factors contributing to this significant difference is thought to
be the influence of differences in physicians’ orders and activity poli-
cies according to the tracheal intubation protocol in each area Med-
ical control committees even within the same prefecture. Based on
the results of tracheal intubation in each region, it is necessary for
the Medical control committees to develop a protocol and discuss
a course of action. As for the comparison between VL and ML in
each area, the success rate of VL was higher than that of ML in all
areas except for the area where the success rate was 100% in both
groups, suggesting the usefulness of VL.
Limitations of the study
ROSC rates and CPC1-2 in this study were observational studies
using Utstein style data and emergency transport data, and there
may be confounding in the background of OHCA injuries. The study
also has a number of limitations: it is a retrospective study limited to
Hiroshima Prefecture; the skills of the EMTs who performed tracheal
intubation were not evaluated; and the quality of chest compressions
was not assessed.
Conclusion
Our data suggest that using VL had a little advantage with a higher
success rate and lower complication rate. Further discussion is
needed on the development of EMS intubation devices for rapid
and safe endotracheal intubation in OHCA, based on clinical results
on tracheal intubation in various regions.
Conflict of interest
All authors of this paper have no defined COI.
Acknowledgement
We would like to express my deepest gratitude and appreciation to
the people involved in the Hiroshima Prefecture Medical Control
committees, the Hiroshima Prefecture Fire Department, and
Kokushikan University.
Author details
a
Research Institute of Disaster Management and EMS, Kokushikan
University,Tokyo, Japan
b
Department of Emergency Medical System,
Graduate School, Kokushikan University , Tokyo, Japan
c
Hiroshima
Prefectural Hospital Emergency and Critical Care Medici-
ne
d
Emergency and Intensive Care Medicine, Hiroshima Universi-
ty
e
Research Center for Mathematical Medicine, Tokyo, Japan
REFERENCES
1. Japan Resuscitation Council. JRC Resuscitation Guidelines
2020. Tokyo: Igaku Shoin; 2021. p. 56–60.
Table 4 – Success rate and number of implementations by region.
Overall
success rate
Video
laryngoscope
Macintosh
laryngoscope
P-value RR (95%CI) Number of
implementation
per million
population
All of Hiroshima Prefecture 92.0% (815/885) 94.1% (490/521) 89.3% (325/364) 0.01 1.05 (1.01–1.10) 345
HA Region 100% (35/35) 100% (30/30) 100% (5/5) 0 244
HB Region 97.2% (104/107) 97.9% (95/97) 90.0% (9/10) 0.26 1.09 (0.88–1.34) 1,263
HC Region 93.1% (335/360) 95.0% (134/141) 91.8% (201/219) 0.24 1.03 (0.98–1.09) 1,498
HD Region 92.1% (210/228) 92.2% (130/141) 91.9% (80/87) 0.95 1.00 (0.93–1.08) 166
HE Region 87.7% (121/138) 91.3% (94/103) 77.1% (27/35) 0.03 1.18 (0.97–1.43) 580
HF Region 58.8% (10/17) 77.8% (7/9) 37.5% (3/8) 0.15 2.07 (0.79–5.42) 33
HAHF: 6 areas in Hiroshima Prefecture.
The success rate of each tracheal intubation is expressed as a % (real number).
(): The left side is the number of successes ・Implementations / Total number.
Group comparisons were made using the Pearson’s chi-square test and Fisher’s exact test to estimate RR and 95% CI.
Based on the total population of each area, the number of people for whom tracheal intubation was attempted was converted to a number per million population.
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