Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial

• Published in: The American journal of emergency medicine Vol. 33; no. 11; pp. 1547 - 1551
• Main Authors: Szarpak, Lukasz, PhD, MPH, EMT-P, Truszewski, Zenon, PhD, MD, Czyzewski, Lukasz, PhD RN, Kurowski, Andrzej, PhD, MD, Bogdanski, Lukasz, MD, Zasko, Piotr, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015; Elsevier Limited
• Subjects: Adult; Airway management; Allied Health Personnel; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - instrumentation; Cardiopulmonary Resuscitation - methods; Child; Clinical Competence; CPR; Cross-Over Studies; Edema; Emergency; Emergency medical care; Female; Humans; Intubation; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Laryngoscopes; Male; Manikins; Paramedics; Pediatrics; Prospective Studies; Success; Time Factors; Ventilation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.06.003

Abstract Introduction The main cause of cardiac arrest in pediatric patients is respiratory failure. Objective To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios. Methods This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC. Results A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P = .73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P = .67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC ( P < .05) for all analyzed variables. Conclusions This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.