Can use of video laryngoscopes by emergency medical technicians facilitate endotracheal intubation during continuous chest compression? A manikin study

Introduction: We conducted this study to evaluate the utility of two video laryngoscopes (VLs) [PentaxAWS (AWS), GlideScope (GVL)], compared to the conventional Macintosh laryngoscope (ML), on endotracheal intubation (ETI) involving chest compressions by Level 1 Korean emergency medical technicians (EMTs) who are the equivalent of EMT-I in the United States. Methods: This was a randomised crossover simulation study. Fifty EMTs performed endotracheal intubation in randomised sequence following two different scenarios: normal airway and difficult airway. Results: In normal airway scenario, overall success rate did not differ between the three devices. However AWS required a shorter run-time (14.1 [10.9-19.8] seconds) to complete ETI (T_C) than ML (17.7[13.5-21.3] seconds) (p=0.017). And both VLs showed a significant superiority over ML in time required to visualise vocal cords (T_VC), percentage of glottic opening (POGO) score, and incidence of dental compression (I_DC). In difficult airway scenario, overall success rate of both VLs was significantly higher than ML. The T_C of AWS (13.7 [11.2-16.9] seconds) and GVL (20.7 [15.1-25.9] seconds) was shorter than that of ML (24.7 [18.1-34.5] seconds) (p<0.001). The T_VC of GVL was significantly shorter than that of AWS and ML. The POGO score, I_DC, and ease of intubation were significantly superior with AWS, GVL, and ML, respectively. Conclusions: Video laryngoscopes can facilitate EMT performing a faster and easier intubation without interrupting chest compressions. Moreover, AWS improves the success rate comparing to ML in difficult airway management.