Endotracheal intubation may be needed in critically ill patients in the prehospital setting, where difficult conditions may be encountered. The patient may be lying on the ground, thus complicating direct laryngoscopy as the operator's visual axis cannot be properly aligned with the patient's oral-pharyngeal-tracheal axis. The posture sitting cross-legged ("Lotus" position) at the head of the patient may allow an easier alignment of the visual axes due to a lower operator's head position and more stability. We compared the impact of the "Lotus" position with free positioning of the operator for direct laryngoscopy on intubation first pass success rate among novice operators.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
72
Participants are not given instructions on how to position for intubation using direct laryngoscopy.
Participants are requested to sit cross-legged for intubation using direct laryngoscopy.
Hôpitaux Universitaires de Genève
Geneva, Canton of Geneva, Switzerland
First Pass Success rate
In percentage, defined as achieving successful ETI on the initial attempt. An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt.
Time frame: Periprocedural
Time to Intubation
Time in seconds from blade insertion at the dental arch to successful ventilation. A maximum of 60 seconds was allowed per ETI attempt.
Time frame: Periprocedural
Time to Intubation for the first intubation attempt alone
Time in seconds from blade insertion at the dental arch to adequate ventilation, ruling out first-attempt failures. A maximum of 60 seconds was allowed per ETI attempt.
Time frame: Periprocedural
Number of intubations attempts
An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt.
Time frame: Periprocedural
Cormack and Lehane (CL) score
For each attempt, the view of the larynx was assessed by the participant using the Cormack-Lehane score.
Time frame: Periprocedural
Percentage Of Glottis Opening (POGO) score
For each attempt, the percentage of glottis opening was assessed by the participant, using the POGO score.
Time frame: Periprocedural
Subjective assessments
Perceived difficulty was appraised using a 5-point Likert scale ranging from "Totally Agree" to "Totally Disagree".
Time frame: Periprocedural
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