The success of endotracheal intubation with a modified laryngoscope using night vision goggles

BACKGROUND: Endotracheal intubation (ETI) procedure in the combat area differs from prehospital trauma life support procedures because of the danger of gunfire and the dark environment. We aimed to determine the success, difficulty degree, and duration of ETI procedures with a classical laryngoscope (CL) in a bright room and with a modified laryngoscope (ML) model in a dark room.
METHODS: All interventions were performed by a combatant medical staff of 10 members. We developed an ML model to obtain a tool that can be used in combination with night vision goggles (NVGs) to perform ETI at night. The procedures were performed using a CL with the naked eye in a bright room and using a ML with NVGs in a dark room. The ETI procedure that used the ML was performed by engaging and locking the blade on the handle either in the mouth (ML-IM) or outside of the mouth (ML-OM).
RESULTS: The mean completion times for the ETI procedures, namely Day-CL, ML-OM+NVG, and ML-IM+NVG, performed by the operators were 14.46, 26.9, and 32.38 s, respectively. The ML-OM+NVG and ML-IM+NVG procedures were significantly longer than the Day-CL procedure (p<0.05). The ML-IM+NVG procedure was significantly longer than the ML-OM+NVG procedure (p<0.05). All ETI procedures were found to be 100% successful. The Day-CL procedure was easier than the ML-OM+NVG and ML-IM+NVG procedures (p>0.05).
CONCLUSION: The ETI procedure is applicable using NVGs in dark conditions on the battlefield. Medical interventions performed using NVGs in the dark should be a part of the basic training provided in tactical emergency medicine.

Gece görüþ gözlükleri kullanarak modifiye laringoskopla endotrakeal entübasyon baþarýsý

AMAÇ: Karanlýk ortamda düþman ateþi altýnda endotrakeal entübasyon (ETE) prosedürü hastane öncesi travma yaþam desteði prosedürlerinden farklýdýr. Amacýmýz; aydýnlýk odada klasik laringoskop (KL), karanlýk odada modifiye laringoskop (ML) modeli ile ETE prosedürlerinin baþarý, zorluk derecesi ve ETE prosedür süresini ortaya çýkartmaktýr.
GEREÇ VE YÖNTEM: Tüm giriþimler 10 kiþiden oluþan muharip saðlýk personeli tarafýndan yapýldý. Gece koþullarýnda, gece görüþ gözlükleri (GGG) ile ETE prosedürünün gerçekleþtirmek için ML modeli geliþtirdik. Giriþimler; KL kullanýlarak aydýnlatýlmýþ bir alanda ve ML ile GGG kullanýlarak karanlýkta gerçekleþtirildi. Modifiye laringoskop býçaðý aðýz içinde (ML-AÝ+GGG) veya aðýz dýþýnda (ML-AD+GGG) açýlacak þekilde iki ayrý metod þeklinde kullanýldý.
BULGULAR: Uygulayýcýlar tarafýndan aydýnlýk ve karanlýk odada yapýlan ETE giriþimlerinin (Gündüz-KL, ML-AD+GGG, ML-AÝ+GGG) ortalama tamamlanma süreleri sýrasýyla 14.46 sn., 26.9 sn., ve 32.38 sn. olarak saptandý. ML-AD+GGG ve ML-AÝ+GGG, Gündüz-KL’ye göre istatistiksel olarak anlamlý derecede daha uzundu (p<0.05). Modifiye laringoskop-AÝ+GGG, ML-AD+GGG’ye göre göre istatistiksel olarak anlamlý derecede daha uzun bulundu (p<0.05). Bütün ETE giriþimleri %100 baþarýlýydý. Gündüz-KL, ML-AD+GGG ve ML-AÝ+GGG ile karþýlaþtýrýldýðýnda daha kolaydý (p<0.05).
TARTIÞMA: Endotrakeal entübasyon savaþ alanýnda GGG kullanarak karanlýkta uygulanabilir bir prosedürdür. Gece görüþ gözlükleri ile karanlýkta yapýlan týbbi müdahaleler, taktik acil týbbýnda verilen temel eðitimlerin bir parçasý olmalýdýr.