Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study

Area of Science:

• Anesthesiology
• Medical Simulation
• Emergency Medicine

Background:

• Airway management is critical in emergency situations.
• Chemical protective equipment can impede intubation performance.
• Evaluating laryngoscopes under these conditions is essential.

Purpose of the Study:

• To compare the performance of four laryngoscopes (Macintosh, Airtraq, Glidescope, AP Advance) during endotracheal intubation.
• To assess vocal cord visualization and intubation time while wearing full chemical protective gear.
• To determine the most effective laryngoscope in challenging scenarios.

Main Methods:

• 42 anaesthetists performed manikin-based endotracheal intubations.
• Participants wore full chemical protective equipment.
• Four laryngoscopes (Macintosh, Airtraq, Glidescope, AP Advance) were evaluated.
• Primary endpoint: time to intubation; Secondary outcomes: glottis visualization (Cormack-Lehane score) and equipment-related impairments.

Main Results:

• The AP Advance (APA) facilitated significantly faster intubation times (23.6 s) compared to Macintosh (31.4 s), Glidescope (35.4 s), and Airtraq (37.1 s).
• APA also provided significantly improved visualization of the vocal cords compared to the Glidescope.
• All intubations were completed successfully within adequate timeframes despite protective gear.

Conclusions:

• The AP Advance laryngoscope is a highly effective device for endotracheal intubation when wearing chemical protective equipment.
• APA offers advantages in speed and visualization, suitable for anaesthetists of all experience levels.
• This study highlights the importance of device selection in high-risk environments.