Comparative Evaluation of the McGrath Videolaryngoscope and the Direct Laryngoscopy for Tracheal Intubation in the Prehospital Setting
- Conditions
- Respiratory FailureCardio Respiratory ArrestIndication of Orotracheal IntubationNeurological Failure
- Interventions
- Device: Direct laryngoscopy groupDevice: Videolaryngoscopy group
- Registration Number
- NCT04930419
- Lead Sponsor
- Assistance Publique - Hôpitaux de Paris
- Brief Summary
In the prehospital setting, the risk of difficult intubation and life-threatening complications is increased under particular conditions due to the environment or the frequent instability of patients.
To limit this risk procedures and devices to ease and secure tracheal intubation must be developped and integrated.
As the prevalence of complications increase with the number of attempts of intubation, one strategy is to facilitate the intubation technic itself.
Direct laryngoscopy with Macintosh blades is the standard device commonly used in first place for tracheal intubation.
Other devices are available and used, mostly for difficult intubation, included videolaryngoscopy. This device has been used and studied for years now. Allowing a better view and glottic visualisation, videolaryngoscopy could increase the first-pass success rate.
Among all videolaryngoscopes, the McGrath videolaryngoscope is the most similar device to the standard Macintosh laryngoscope. It is light, compact, with a screen directly linked to the handle, easy to use and offering excellent view. Its usability and efficacy make it a device of choice for the prehospital setting and worth further clinical trials to define its place in the airway strategy.
Hypothesis: In the prehospital setting, the use of McGrath videolaryngoscope as the primary device for tracheal intubation could facilitate tracheal intubation and decrease the number of attempts of intubation and complications.
The objective of our study is to determine if the use of McGrath videolaryngoscope increase the rate of successful first-pass intubation in the prehospital setting compared to direct view Macintosh laryngoscopy.
The primary outcome is the rate of successful intubation at the first attempt. One attempt is defined as an advancement of the tube towards the glottis during a laryngoscopy ; every new try even during the same laryngoscopy is considered as a new attempt.
Successful intubation is confirmed by the visualisation of 6 waves of EtCO2.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 150
- Age more than 18
- Indication of orotracheal intubation
- Operators trained to the use of the McGrath
- Pregnancy
- No insurance
- Major patient under guardianship or curatorship
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Direct laryngoscopy group Direct laryngoscopy group - Videolaryngoscopy group Videolaryngoscopy group -
- Primary Outcome Measures
Name Time Method Rate of successful intubation at the first attempt up to 10 minutes post inclusion One attempt is defined as an advancement of the tube towards the glottis during a laryngoscopy ; every new try even during the same laryngoscopy is considered as a new attempt.Successful intubation is confirmed by the visualisation of 6 waves of EtCO2.
- Secondary Outcome Measures
Name Time Method Number of attempts needed for successful intubation up to 10 minutes post inclusion Proportion of difficult intubations up to 10 minutes post inclusion Difficult intubation will be evaluated by the intubation difficulty score (score IDS or difficulty of intubation under laryngoscopy score ). It goes from 0 to infinity. zero indicating an easy intubation and infinity being an impossible intubation
Type of complications per and post-intubation up to 10 minutes post inclusion Time to intubate up to 10 minutes post inclusion Time to intubate will be defined by the time between the insertion of the device in the mouth and the visualisation of the first waves of EtCO2
Reason of failure of the first-pass success up to 10 minutes post inclusion Reasons of failure will be defined as following :
* Bad glottic visualization
* Difficult progression of the tube towards the glottis despite a good visualisation
* Presence of secretions
* Presence of foreign body
* Presence of fogging on the McGrath
* Device failure
* OtherGlottic view up to 10 minutes post inclusion Glottic view will be evaluated with Cormack and Lehane grade and POGO score. POGO score goes from 0 (Visualization of the language base) to 100% (total visualization of the glottis). Cormack and Lehane grade goes from I to IV. A higher Cormack and Lehane grade is worth : I indicate total visualization of the glottis and IV indicate Visualization of the language base
Proportion of cases needed crossovers to other rescue techniques up to 10 minutes post inclusion Proportion of cases who need for tools to optimize up to 10 minutes post inclusion Proportion of decision of switch in case of failure up to 10 minutes post inclusion Number of deaths up to 10 minutes post inclusion Number of complications per and post-intubation up to 10 minutes post inclusion
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