Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment

• Published in: The American journal of emergency medicine Vol. 53; pp. 122 - 126
• Main Authors: Szarpak, Lukasz, Peacock, Frank W., Rafique, Zubaid, Ladny, Jerzy R., Nadolny, Klaudiusz, Malysz, Marek, Dabrowski, Marek, Chirico, Francesco, Smereka, Jacek
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Airway management; Airway Management - instrumentation; Airway Management - methods; Airway Management - statistics & numerical data; Allied Health Personnel - standards; Allied Health Personnel - statistics & numerical data; Cardiopulmonary resuscitation; Coronaviruses; COVID-19; Emergency medical care; Emergency medical services; Endotracheal intubation; Female; Health services; Heart; Humans; Intubation; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Intubation, Intratracheal - statistics & numerical data; Laryngoscopes - standards; Laryngoscopes - statistics & numerical data; Laryngoscopy; Male; Medical personnel; Middle Aged; Patients; Personal protective equipment; Personal Protective Equipment - adverse effects; Personal Protective Equipment - standards; Personal Protective Equipment - statistics & numerical data; Prospective Studies; Protective equipment; Resuscitation - instrumentation; Resuscitation - methods; Resuscitation - statistics & numerical data; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Software; United States > US; Personal protective equipment; COVID-19; Airway management; SARS-CoV-2; Cardiopulmonary resuscitation; Endotracheal intubation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.12.069

Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43–92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of −48 s (95%CI confidence interval [CI], −60.23, −35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. Trial registration: ClinicalTrials registration number NCT04365608