Ulus Travma Acil Cerrahi Derg. 2023; 29(4): 463-470 | DOI: 10.14744/tjtes.2022.45682

Impact of VieScope® on first-attempt success during simulated COVID-19 patients intubation: A randomized cross-over simulation trial

Togay Evrin¹, Leyla Öztürk Sönmez², Lezsek Gadek³, Michal Pruc³, Alla Navolokina⁴, Wojciech Wieczorek⁵, Maciej Cyran⁶, Jacek Smereka⁷, Gül Deniz Özkan^8
1Department of Emergency Medicine, Ufuk University Faculty of Medicine, Dr. Rýdvan Ege Training and Research Hospital, Ankara-Türkiye
²Department of Emergency Medicine, Beyhekim Training and Research Hospital, Konya-Türkiye
³Research Unit, Polish Society of Disaster Medicine, Warsaw-Poland
⁴International European University, Kyiv-Ukraine
⁵Department of Emergency Medicine, Medical University of Warsaw, Warsaw-Poland
⁶Institute of Outcomes Research, Maria Sklodowska-Curie, Warsaw-Poland
⁷Department of Emergency Medical Service, Medical University of Wroclaw, Wroclaw-Poland
⁸Department of Emergency Medicine, Þanlýurfa Mehmet Akif Ýnan Training and Research Hospital, Þanlýurfa-Türkiye

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs).
METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random.
RESULTS: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32–40) seconds and 35.8 (IQR: 30–40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001).
CONCLUSION: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

Keywords: COVID-19, endotracheal intubation; laryngoscope; Macintosh; personal protective equipment; SARS-CoV-2, VieScope®.

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Simule edilmiþ COVID-19 hastalarýnýn entübasyonunda ilk giriþim baþarýsýna VieScope®’un etkisi: Randomize çapraz simulasyon çalýþmasý

Togay Evrin¹, Leyla Öztürk Sönmez², Lezsek Gadek³, Michal Pruc³, Alla Navolokina⁴, Wojciech Wieczorek⁵, Maciej Cyran⁶, Jacek Smereka⁷, Gül Deniz Özkan^8
1Ufuk Üniversitesi Doktor Rýdvan Ege Eðitim ve Araþtýrma Hastanesi, Acil Týp Bilimdalý, Ankara
²Beyhekim Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Konya
³Polonya Afet Týbbý Derneði, Araþtýrma Birimi, Varþova-Polonya
⁴Uluslararasý Avrupa Üniversitesi, Kiev-Ukrayna
⁵Varþova Týp Üniversitesi, Acil Týp Departmaný, Varþova-Polonya
⁶Sonuç Araþtýrmalarý Enstitüsü, Maria Sklodowska- Curie, Varþova-Polonya
⁷Wroclaw Týp Üniversitesi, Acil Servis Departmaný, Wroclaw-Polonya
⁸Þanlýurfa Mehmet Akif Ýnan Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Þanlýurfa

AMAÇ: Çalýþmamýzýn amacý, aerosol oluþturma prosedürleri (AGP’ler) için kiþisel koruyucu ekipman (PPE) giyen saðlýk görevlileri tarafýndan simüle edilmiþ COVID-19 hastalarýnýn farklý senaryolarýnda VieScope® ve Macintosh laringoskop ile entübasyonun etkinliðini belirlemekti.
GEREÇ VE YÖNTEM: Çalýþma ileriye yönelik, gözlemsel, randomize ve çapraz tasarlanmýþ simülasyon çalýþmasý olarak tasarlanmýþtýr. Çalýþmaya 37 saðlýk görevlisi katýldý. COVID-19 olduðundan þüphelenilen hastalarýn endotrakeal entübasyonunu (ETI) gerçekleþtirdiler. Entübasyon, iki araþtýrma senaryosunda VieScope® ve Macintosh laringoskoplar kullanýlarak gerçekleþtirildi: Senaryo A - normal hava yolu ve Senaryo B - zor hava yolu olarak tasarlandý. Hem katýlýmcýlarýn sýrasý hem de entübasyon yöntemleri rastgele idi.
BULGULAR: Senaryo A’da VieScope® ve Macintosh laringoskop kullanýlarak entübasyona kadar geçen süre (TTI) sýrasýyla 35.3 (IQR; 32–40) sa-niye ve 35.8 (IQR: 30–40) saniye idi. Neredeyse tüm katýlýmcýlar hem VieScope® hem de Macintosh laringoskop ile ETI’yi baþarýyla gerçekleþtirdi (%100’e vs. %94.6). B senaryosunda, Macintosh laringoskop ile karþýlaþtýrýldýðýnda VieScope® ile entübasyon, daha kýsa entübasyon süresi (p<0.001), ilk entübasyon giriþiminde daha yüksek baþarý oraný (p<0.001), daha iyi görüntü alma (p=0.012) ve entübasyonun daha kolay olduðu saptanmýþtýr (p<0.001).
TARTIÞMA: Analizimiz, PPE-AGP’yi kullanan saðlýk görevlileri tarafýndan gerçekleþtirilen zor hava yolu entübasyonunda Macintosh laringoskopa kýyasla VieScope® kullanýmýnýn daha kýsa entübasyon süreleri, daha yüksek entübasyon verimliliði ve ayrýca glottisin daha iyi görüntülenmesi ile iliþkili olduðunu göstermektedir. Elde edilen sonuçlarý doðrulamak için ek klinik deneyler gereklidir.

Anahtar Kelimeler: COVID-19, endotrakeal entübasyon; kiþisel koruyucu ekipman; laringoskop; Macintosh; SARS-CoV-2; VieScope®.

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