Comparison of various intubation deviced during resuscitation of COVID-19-suspected patients by paramedics wearing personal protective equipment

Abstract

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.