Difficult Intubation Clinical Trial
Official title:
Comparison of a Macintosh Laryngoscope and Endotracheal Tube Introducer During Chest Compression in a Manikin: Randomized, Prospective, Cross-over Study
In this prospective, randomized, cross-over study, investigators aimed to compare the first pass successes of inexperienced doctors with Macintosh laryngoscopy and endotracheal tube introducer on a manikin with continuous chest compression in the ambulance simulation in the pre-hospital process.
This study is a prospective, cross-over manikin study which is based on an ambulance
simulation. Written inform consent was obtained from all doctors who agreed to participate to
the study. Inexperienced doctors who attended in Kocaeli between February 2018 and March 2018
will be included to the survey. Novice doctors participated to this research. The research
will be carried out in the department of emergency medicine of Derince training and research
hospital. In order to prevent bias, the eight-hour training module for the participants ,
theoretical and practical airway training will be provided by an emergency medical specialist
who has no knowledge about the research.
The participants will be informed about the study after the training. Doctors who participate
to the study will be included after the written inform consent is obtained. The participants
will be informed about the research, but they will be blind to the specific purposes of the
study. The participants will practice for 5 minutes on the manikin by themselves and with the
emergency medicine specialist if they ask for. Life / form® Deluxe Crisis ™ Manikin Torso
with Advanced Airway Management will be used as the research manikin. The participants will
perform airway interventions in the sitting position and the height of the stretcher will be
set at the same height with the ambulance stretcher. Practitioner's seat will be set on the
same height with the ambulance seat. 8.0 (mm ID) endotracheal tube will be used for the
procedure. Endotracheal tube and manikin airway will be lubricated with pump spray lubricant
provided with the simulator. Airway manikin will be in supine position. Lund University
Cardiac Arrest System-version 2 (LUCAS 2TM) automatic chest compression device will be used
to provide 5 cm compression depth and 100 chest compressions per minute in order to provide
standardization in chest compression and prevent bias created by practitioners. The airway
devices will be next to the model's head.
The study was planned as a randomized, crossover clinical trial to reduce the influence of
the learning. Equal numbers 1 and 2 will be written on the same sized papers to provide
randomization. All papers will be folded in the same way and placed inside brown and
invisible envelopes. All of the envelopes will be placed in the same box. After the training,
every doctor will be asked to choose one of the envelopes. After separating the participants
into two groups, doctors that drawed envelop number 1 will be asked to intubate by using only
No. 3 Macintosh blade. The doctors that drawed envelop number 2 will be asked to intubate
with the adult size endotracheal tube introducer with using No. 3 Macintosh laryngoscopy.
After the groups completed their interventions, those who drawed envelope number 1 will be
asked to intubate with Macintosh laryngoscopy using endotracheal tube introducer and those
who drawed envelope number 2 will be asked to intubate with Macintosh laryngoscopy. Each
doctor will be given 1 minute for each successful intervention. Each practitioner will make
maximum 2 trial attempts for each method. The initiation time is considered to be taking the
laryngoscopy on hand. After ventilation, the manikin's chest wall movement is considered as a
successful intervention. All transactions will be recorded with a camera that is placed in
the room and the participants will have the information about the presence of the camera. The
first intervention success , intubation time, the number of interventions of the participants
will be recorded. After the interventions are over, the participants will be asked to rate
the difficulty of the ventilation methods according to the Likert scale as 1-very easy,
2-easy, 3-medium, 4-difficult 5- very difficult. In addition, they will be asked whether they
have any experiences with Macintosh laryngoscopy or endotracheal tube introducer and their
responses will be recorded.
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