Proficiencies of military medical officers in intubating difficult airways
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RESEARCH ARTICLE
Open Access
Proficiencies of military medical officers in intubating difficult airways Jonathan ZM Lim1*, Shi Hao Chew1, Benjamin ZB Chin1 and Raymond CH Siew2
Abstract Background: This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method: One hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results: The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s. Conclusion: Military medical officers with 2–3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC. Keywords: Trauma, Airway, Manikin, Junior doctors, Laryngoscopes
Background Placement of a cuffed endotracheal tube (ETT) in the trachea remains the definitive airway management when resuscitating collapsed patients and treating severely injured trauma casualties [1, 2]. Direct Laryngoscopy (DL) is the primary method for tracheal intubation, but it becomes challenging when performed under emergency trauma conditions where casualties can have possible orofacial trauma or head and neck injuries. Repeated attempts and prolonged tracheal intubation can also result in significant morbidities, and this happens more frequently when tracheal intubation via DL is attempted by * Correspondence: [email protected] 1 Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore Full list of author information is available at the end of the article
inexperienced operators or junior doctors [3–8]. The advent of video laryngoscopes (VL) has markedly improved visualization of the glottis via indirect laryngoscopy, and some studies suggest that VL may improve first-pass intubation success by non-experts [9, 10]. VLs play an important role in difficult airway algorithms [11, 12]. However, recent studies have called into question the utility of VL when intubating emergency and critical
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