© Borgis - Postępy Nauk Medycznych 2/2018, s. 120
*Michal Cieciel, Roman Konski
Endotracheal intubation – gold standard or myth?
Intubacja dotchawicza – złoty standard czy mit?
Emergency Medicine Student Scientific Circle, Department of Emergency Medicine, Medical University of Warsaw, Poland
To the Editor,
We read with great interest article by Szarpak et al. (1) analyzing the effect of chest compressions on the quality of endotracheal intubation. This study raises an extremely important problem – airway management with minimal interruption in chest compressions. The European Resuscitation Council guidelines for adult advanced life support endotracheal intubation as the “gold standard” in airway management (2). However, due to the need to minimize chest compressions interruption the guidelines recommend that endotracheal intubation should be performed by the most experienced team member with no or only with a short interruption in chest compression allowing the insertion of the endotracheal tube through the vocal folds (fig. 1). According to the study by Szarpak et al. (1), chest compressions affect the time of the intubation procedure and reduce its effectiveness. When using videolaryngoscopy, we can avoid this problem because it is possible to visualize the glottis to a better extent and to introduce the endotracheal tube directly under the video control. Confirmation of results obtained by Szarpak et al. (1) can also be found in other studies by leading researches in this field (3-5). Studies by Madziala et al. (6, 7) indicate that inexperienced in endotracheal intubation with direct laryngoscopy personnel, is able to perform endotracheal intubation with the use of the AirTraq videolaryngoscope with high efficiency. Szarpak et al. (1) in his study indicate limitations resulting from performed study. One of the unquestionable limitations is the availability of videolaryngoscopes. Currently, they are used in emergency units, anesthesiology and intensive care departments and on operating theatres. However, it should be remembered that difficult airway may also affect patients in pre-hospital conditions, including Emergency Medical Services teams. It is therefore important to promote direct endotracheal intubation alternatives and to search for the most effective and safe methods of airway management. for the most effective and safe methods of airway management.
Fig. 1. Intubation using videolaryngocope
1. Szarpak L, Madziala A, Dabrowski M et al.: Impact of chest compression on endotracheal intubation efficacy: a randomized crossover trial. Post N Med 2018; 31(1): 48-53.
2. Link MS, Berkow LC, Kudenchuk PJ et al.: Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132(18 suppl. 2): S444-464.
3. Reyhan N, Goksu E, Kaplan A et al.: Comparison of C-MAC, McGrath and Macintosh laryngoscope use in a standardized airway manikin with immobilized cervical spine by novice intubators. Am J Emerg Med 2017; 35(9): 1368-1370.
4. Klosiewicz T, Sip M, Zalewski R et al.: Alternative of endotracheal intubation for paramedics to provide direct laryngoscopy. The randomized manikin trial. Disaster Emerg Med J 2017; 2(3): 142-144.
5. Madziala A, Evrin T, Wieczorek W et al.: Can the face-to-face intubation technique be used during cardiopulmonary resuscitation? A prospective, randomised, crossover manikin trial. Disaster Emerg Med J 2017; 2(4): 145-149.
6. Madziala A, Galazkowski R, Kaminska H et al.: Comparison of the airway access skills of medical students in cardiopulmonary resuscitation simulation: a randomized crossover study. Post N Med 2018; 31(1): 42-47.
7. Szarpak L, Karczewska K, Evrin T et al.: Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial. Am J Emerg Med 2015; 33(7): 946-950.