Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-view^TM VL, UESCOPE^® VL, ProVu^® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. Results: The longest IT was noted when the UESCOPE^® (29.4 s) and ProVu^® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu^®, UESCOPE^® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE^® and ProVu^®. Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE^® and ProVu^® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.

Introduction: The aim of the study was to compare the Intubrite laryngoscope and the standard Macintosh blade laryngoscope (MCL) used by persons with no clinical experience in simulated hospital and non-hospital conditions on a manikin model. Materials and methods: The study involved 50 students of Medical Rescue. The hospital conditions (intubation height 110 cm—high position) and those occurring at the scene (intubation of a manikin located at floor level-low position) were simulated. The analysis included: duration of intubation, visibility of the laryngeal opening by the Cormack–Lehane scale, the bioelectrical activity of the intubating muscles, comfort and subjective assessment of physical effort by the Borg scale (Borg’s scale of subjective feeling of effort). The statistical analysis was performed with Microsoft Excel and T-student tests for pairs with unequal variables. The statistical importance was set at p < 0.05. Results: The use of an Intubrite laryngoscope significantly reduces the mean endotracheal intubation time compared to the Macintosh laryngoscope in a low position (17.34 s versus 19.04 s, p < 0.05). A higher rate of repeat intubations was observed in a low position for MCL (from 10% to 14%, p < 0.05). The reverse is true for Intubrite laryngoscope intubation (from 8% to 4%, p < 0.05 Please explain what is compared). The Intubrite laryngoscope improved visualization of glottis in the high and the low positions compared to the Macintosh laryngoscope (54% and 50% to 52% and 38%, respectively, p < 0.05). The risk of tooth damage was the same for the Intubrite and the MCL laryngoscopes in a high position (16% and 14%, respectively, p > 0.05), while in the simulated out-of-hospital setting, it was significantly higher for the MCL (22% versus 8%, p < 0.05). The subjective comfort of intubation in both simulated situations was similar according to the Borg scale (p-value, values). The use of the Intubrite laryngoscope was associated with less effort than the MCL in high versus low positions. For MCL, intubation in a high position was associated with lower mean muscle activity than in a low position (+48.24 µV versus +58.25 µV, p-value). For the Intubrite laryngoscope, these values were at similar levels (+52.03 µV and +52.65 µV, p-value). Conclusions: The use of the Intubrite laryngoscope by people with no clinical experience shortens the time of intubation and improves the laryngeal view compared to the standard Macintosh laryngoscope, but it requires similar muscle work in simulated conditions.

Background: New devices are more available in the pre-hospital environment operational theaters and emergency departments. One is an intubrite laryngoscope (INT) with Dual LED lighting that combines ultraviolet and white LED. The study aimed to compare the efficacy of endotracheal intubation using INT and conventional laryngoscope performed by inexperienced paramedics (paramedics students) and paramedics with experience in advanced airways management in full and limited accessibility settings. Methods: It was an open, prospective, crossover manikin study. Sixty paramedics and paramedic students were recruited. Participants were divided into 2 equal groups depending on their experience (n = 30). Experienced participants were further randomly divided into 2 groups (n = 15). Inexperienced participants were also randomly divided into 2 groups (n = 15). The criterion of inexperience was 5 or fewer intubation by any laryngoscope. Inexperience participants were asked to perform tracheal intubation in standard pre-hospital settings (without limited access to manikin) (scenario A) and difficult pre-hospital settings (limited access to manikin - narrow space between benches) (scenario B). Experience participants were asked to intubate manikin in difficult pre-hospital settings. Results: In the normal pre-hospital environment, the success rate after the first attempt was 56,7% for conventional laryngoscope and 66,7% for intubrite. However, the overall effectiveness of tracheal intubation using both laryngoscopes in 3 attempts was 90% for both devices. The successful rate of first attempt intubation in a difficult environment by inexperienced was 73,3% for INT and 50% for conventional laryngoscope. Overall effectiveness was 83,3% and 86,7% respectively. The successful rate of first attempt intubation in the experienced group was 86,7% with INT compared to 60% with a conventional laryngoscope in difficult settings. Overall effectiveness was 96,7% for both devices. Conclusion: Intubrite provided better working conditions and make up for deficiencies in successful tracheal intubation by inexperienced participants in a normal and difficult environment. Tracheal intubation with intubrite was more effective in the experienced group. Tracheal intubation effectiveness with intubrite was also higher in the experienced group.

Background: Intubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA. Methods: We performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis. Results: Over a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance. Conclusions: We found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics. Trial Registration: Trial was registered in Clinical Trials: NCT05607836 (10/28/2022)