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- Title
Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial.
- Authors
Xu, Xiaohan; Ma, Haobo; Zhang, Yuelun; Liu, Wei; Jung, Boris; Li, Xu; Shen, Le
- Abstract
Background: Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. Methods: This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. Results: A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. Conclusions: The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. Trial registration: Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
- Subjects
THERAPEUTICS; ACADEMIC medical centers; HUMAN anatomical models; RESEARCH funding; STATISTICAL sampling; SAMPLE size (Statistics); EMERGENCY medical services; RANDOMIZED controlled trials; STRUCTURAL equation modeling; RELATIVE medical risk; DESCRIPTIVE statistics; TRACHEA intubation; LARYNGOSCOPY; CROSSOVER trials; HOSPITAL medical staff; CARDIOPULMONARY resuscitation; DATA analysis software; HEALTH outcome assessment; CONFIDENCE intervals; VIDEO recording; ANESTHESIA; PROPORTIONAL hazards models; REGRESSION analysis
- Publication
BMC Anesthesiology, 2024, Vol 24, Issue 1, p1
- ISSN
1471-2253
- Publication type
Article
- DOI
10.1186/s12871-024-02560-3