The Airtraq Optical Laryngoscope in HEMS: A Pilot Trial

The Airtraq Optical Laryngoscope in Helicopter Emergency Medical Services: A Pilot Trial

Air Medical Journal: Volume 32, Issue 2 , Pages 88-92, March 2013

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum

The objective of this study was to determine the degree of success helicopter emergency medical services personnel have in placing an endotracheal tube using a relatively new device for endotracheal intubation (ETI) known as the Airtraq (AT) Optical Laryngoscope (King Systems Corp, Noblesville, IN), and to determine the frequency with which flight crews had to resort to other means for advanced airway management.

Methods: This prospective, observational pilot trial evaluated the critical care flight team’s ability to perform ETI using the AT as a first-line device in the prehospital setting. Flight crews were instructed to use the AT for any patient needing ETI. Teams completed a 30-minute training session followed by mannequin practice. They documented situations and outcomes: reason for ETI, success in placing the AT, reason for unsuccessful placement, end-tidal carbon dioxide concentration in expired air (ETCO2), and where patients were when they underwent intubation (field, ambulance, aircraft, hospital). Data were abstracted and analysed using JMP software version 7.0 (SAS Institute, Inc, Cary, NC).

Results: Fifty cases involving use of the AT were analysed. Median patient age was 51.5 years (range, 15–90; interquartile range, 36–64.5). Most patients were male (n = 37 [74%]). The primary reasons for intubation were unresponsiveness and altered loss of consciousness (n = 23 [46%]), respiratory distress or apnea (n = 8 [16%]), cardiac arrest (n = 10 [20%]), and combative behaviour (n = 7 [14%]). AT was successful (n = 31[62%]) in 1 to 2 attempts. The primary reason for AT failure was blood or vomit in the airway (n = 8 [42.1%]); 48.1% (n = 25) of patients required a different management mode.

The study found that HEMS crews had difficulty placing successful ET tubes with this device after minimal education with a single regular-sized device. Difficulty was pronounced when blood or vomit was present and obstructing the optical view. The authors believe that further study is needed to evaluate the implementation time, training time required, and possible design advantages of the AT compared with those of traditional emergent airway management techniques. My personal concern is with the statement “minimal education”, I found that after years of using a traditional laryngoscope for intubation it takes a while to change the muscle memory associated with intubation following the move to optical and video laryngoscopes. One of the most effective ways to overcome this is by using the new devices, whether in a clinical environment or simulation laboratory, but for this study the participants received a 30 minute didactic lecture on device function and technique and then manikin practice with a requirement for 2 successful placements.

http://www.airmedicaljournal.com/article/S1067-991X(12)00180-0/abstract?elsca1=etoc&elsca2=email&elsca3=1067-991X_201303_32_2&elsca4=emergency_medicine

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