Evaluation of Airway Scope at Improving the Success Rate of the First Intubation Attempt by Nonexpert Physicians: A Randomized Crossover Manikin Study

Purpose. The aim of the study was to assess the performance of Airway Scope (AWS) on the first attempt at intubation in manikins by nonexpert physicians. Methods. A randomized crossover trial involving seven scenarios. Participants: residents of a cardiovascular hospital. In group A, the AWS procedure was performed first followed by Machintouch Laryngoscopy (ML), while in group B the ML procedure was performed first and then the AWS. The primary outcome assessed was the success of first intubation attempt in a normal scenario. The secondary outcome assessments were success in six other scenarios, and also elapsed time and dental trauma caused in all scenarios. Results. There were 34 participants. All AWS-assisted intubations were successfully completed, but one ML-assisted intubation failed in the normal scenario ( ). The outcomes achieved by the AWS in scenarios involving cervical immobilization ( ), tongue edema ( ), pharyngeal obstruction ( ), and jaw trismus ( ) were superior to those obtained with the ML. Conclusions. Use of AWS-assisted intubation in manikin scenarios results in a significantly high intubation success rate on the first attempt by nonexpert physicians. These findings suggest this new device will be useful for nonexpert physicians in emergency situations. 1. Introduction Tracheal intubation outside the operation room is often performed by physicians who have less experience in airway management than anesthesiologists. The need for emergency airway management in a suboptimal environment can make intubation difficult, and this may affect patient safety. Direct laryngoscopy and intubation remain a challenge to nonexperts [1, 2]. Several different video laryngoscopy devices such as Airway Scope (AWS, Pentax, Tokyo, Japan) provide better laryngeal views than conventional laryngoscopy in controlled setting studies with anesthesiologists [3, 4]. The AWS consists of two components: a display-handle with a fibre-optic scope unit and a disposable blade (Intlock). The shape of the Intlock is designed to provide a view of the glottis without requiring alignment of the oral, pharyngeal, and tracheal axes. Therefore, AWS is thought to be a more useful tool for observing the glottis than a laryngoscope [5]. The aim of the present study was to assess AWS performance in the first tracheal intubation attempt by non-expert physicians. 2. Methods 2.1. Study Design This study was designed as an open randomized crossover manikin trial. The participants were divided into two groups (group A, in which the AWS was used for the first procedure followed by