A pilot, prospective, randomized trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest

Abstract

Abstract 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 randomized, cross-over, non-blinded trial in a single EMS in Poland within a group of 34 ground 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 seconds) 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 higher for INT than MCL but with no statistical significance. Conclusions We found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation with INT higher first attempt success rates as compared to MCL with no statistical significance during CPR by paramedics.