COMPARISON OF VARIOUS INTUBATION DEVICED DURING RESUSCITATION OF COVID-19-SUSPECTED PATIENTS BY PARAMEDICS WEARING PERSONAL PROTECTIVE EQUIPMENT

Abstract

Background: Endotracheal intubation is one of the basic methods for airway control during cardiopulmonary resuscitation. In the era of the prevailing pandemic of SARS-CoV-2, medical personnel may face a necessity of resuscitating aninfected patient. Objective: The objective was to compare three intubation methods for suspected/confirmed COVID-19 adult patient resuscitation performed by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGP). Material and Methods: The multicentre, single-blind, prospective, randomized, crossover simulation trial involved 32 paramedics. The participants wearing PPE AGP performed tracheal intubations with the Macintosh, Airtraq, and McGrath MAC laryngoscopes in a patient with suspected COVID-19 in two resuscitation scenarios: scenario A – without chest compressions; scenario B – with continuous chest compressions. The primary outcome was time to intubation. Results: In scenario A, the intubation time for the respective devices equalled 35 s (IQR: 29–46) vs. 44s (IQR: 35–67) vs. 49 (IQR: 34–72) (p = 0.003). The total efficacy of each intubation method was 100%; however, the efficacy of the first intubation attempt was highest for McGrath MAC (90.6%), followed by Macintosh (68.1%) and Airtraq 62.5%) (p<0.001). In scenario B, the results with McGrath MAC were significantly better than those with Macintosh and Airtraq(p<0.05) for all the analysed variables. Conclusions: In conclusion, the McGrath MAC videolaryngoscope offers better intubation conditions as compared with the Macintosh laryngoscope or Airtraq in the resuscitation COVID-19.

Keywords

• endotracheal intubation
• personal protective equipment
• covid-19
• paramedic
• cardiopulmonary resuscitation