Tracheal intubation during chest compressions performed by qualified emergency physicians unfamiliar with the...

Experienced emergency physicians were recruited and a randomized crossover trial was conducted to compare the performance of the Pentax-Airwayscope (AWS) video-laryngoscope with the Macintosh laryngoscope (McL) for tracheal intubation during continuous chest compressions under three different scenarios: (1) normal airway, (2) limited neck mobility, and (3) tongue edema.

Thirty-six experienced emergency physicians performed intubations on a manikin in each of three scenarios. The sequences of scenarios and intubating devices were randomized. Time to complete intubation (primary end point), time to visualization of the vocal cords, the overall success rate, percentage of glottic opening, dental compression, and ease of intubation were determined.

The times (median [interquartile range]) to complete tracheal intubation were significantly shorter with the AWS than the McL in all three scenarios (11.6 [8.0-14.7] vs. 15.1 [12.8-17.9] s, 13.5 [10.5-20.9] vs. 17.0 [14.1-19.9] s, and 13.6 [11.1-20.9] vs. 15.1 [18.6-37.5] s, respectively). The overall success rates were higher with the AWS than the McL in the difficult intubation scenario (77.8 vs. 100%). The AWS was also more effective than the McL with respect to the percentage of glottic opening, dental compression, and ease of intubation in all three scenarios.

Although participants were experienced emergency physicians familiar with the McL and unfamiliar with the AWS, the AWS proved to be a better tool than the McL to perform tracheal intubation during continuous chest compressions on a manikin. The AWS should be considered as an initial intubating tool to perform tracheal intubation during continuous chest compressions rather than the McL.