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Article

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

by
Leszek Gadek
1,
Lukasz Szarpak
1,2,3,*,
Lars Konge
4,
Marek Dabrowski
1,5,
Dominika Telecka-Gadek
1,6,
Maciej Maslanka
1,2,
Wiktoria Laura Drela
7,
Marta Jachowicz
7,
Lukasz Iskrzycki
8,
Szymon Bialka
9,
Frank William Peacock
10 and
Jacek Smereka
8
1
Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
2
Instutite of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
3
Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-026 Bialystok, Poland
4
Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, University of Copenhagen, 2100 Copenhagen, Denmark
5
Department of Medical Education, Poznan University of Medical Sciences, 60-529 Poznan, Poland
6
Department of Emergency Medicine, Medical University of Warsaw, 02-005 Warsaw, Poland
7
Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
8
Department of Emergency Medical Service, Wroclaw Medical Univesity, 51-618 Wroclaw, Poland
9
Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 41-800 Katowice, Poland
10
Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(24), 5740; https://doi.org/10.3390/jcm10245740
Submission received: 26 October 2021 / Revised: 4 December 2021 / Accepted: 7 December 2021 / Published: 8 December 2021
(This article belongs to the Special Issue Airway Management - State of Art)
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Abstract

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.
Keywords: direct laryngoscopy; video-laryngoscopes; SARS-CoV-2; COVID-19; McGrath MAC; personal protective equipment; medical simulation direct laryngoscopy; video-laryngoscopes; SARS-CoV-2; COVID-19; McGrath MAC; personal protective equipment; medical simulation

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MDPI and ACS Style

Gadek, L.; Szarpak, L.; Konge, L.; Dabrowski, M.; Telecka-Gadek, D.; Maslanka, M.; Drela, W.L.; Jachowicz, M.; Iskrzycki, L.; Bialka, S.; et al. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J. Clin. Med. 2021, 10, 5740. https://doi.org/10.3390/jcm10245740

AMA Style

Gadek L, Szarpak L, Konge L, Dabrowski M, Telecka-Gadek D, Maslanka M, Drela WL, Jachowicz M, Iskrzycki L, Bialka S, et al. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. Journal of Clinical Medicine. 2021; 10(24):5740. https://doi.org/10.3390/jcm10245740

Chicago/Turabian Style

Gadek, Leszek, Lukasz Szarpak, Lars Konge, Marek Dabrowski, Dominika Telecka-Gadek, Maciej Maslanka, Wiktoria Laura Drela, Marta Jachowicz, Lukasz Iskrzycki, Szymon Bialka, and et al. 2021. "Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial" Journal of Clinical Medicine 10, no. 24: 5740. https://doi.org/10.3390/jcm10245740

APA Style

Gadek, L., Szarpak, L., Konge, L., Dabrowski, M., Telecka-Gadek, D., Maslanka, M., Drela, W. L., Jachowicz, M., Iskrzycki, L., Bialka, S., Peacock, F. W., & Smereka, J. (2021). Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. Journal of Clinical Medicine, 10(24), 5740. https://doi.org/10.3390/jcm10245740

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