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NOTARZT 2019; 35(01): 23-31
DOI: 10.1055/a-0747-6327
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Ein Vergleich unterschiedlicher Videolaryngoskopsysteme in der präklinischen Notfallintubation: eine prospektive, randomisierte Multicenterstudie

A Comparison of Different Video Laryngoscopes for Prehospital Emergency Intubation: a Prospective, Randomized Multicenter Study
Erol Cavus
1   Anästhesie, Anästhesie Partner Holstein im MARE Klinikum, Kiel-Kronshagen
2   Medizinische Fakultät der Christian-Albrechts-Universität zu Kiel
,
Sebastian Janssen
3   Anästhesiologie und operative Intensivmedizin, FEK Friedrich-Ebert-Krankenhaus Neumünster GmbH, Neumünster
,
Florian Reifferscheid
4   Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
,
Amke Caliebe
5   Institut für Medizinische Informatik und Statistik, Christian-Albrechts-Universität zu Kiel, Kiel
,
Andreas Callies
6   Klinik für Anästhesie, Operative und Allgemeine Intensivmedizin, Klinikum Links der Weser gGmbH, Bremen
,
Martin von der Heyden
7   Klinik für Anästhesiologie-Anästhesie-, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald
,
Peer G. Knacke
8   Zentrum für Anästhesie und Rettungsmedizin, Sana Kliniken Ostholstein GmbH Klinik Eutin, Eutin
,
Volker Dörges
2   Medizinische Fakultät der Christian-Albrechts-Universität zu Kiel
› Author Affiliations
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Publication History

Publication Date:
13 February 2019 (online)

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Zusammenfassung

Im Rahmen der präklinischen Notfallintubation ist die Erfolgsrate videolaryngoskopischer Systeme mit unterschiedlichen Spateltypen im Vergleich nicht hinreichend untersucht. In der vorliegenden prospektiven, randomisierten, multizentrischen Untersuchung wurden die 3 kommerziell erhältlichen Videolaryngoskope A. P. Advance, C-MAC PM und King Vision an 168 Patienten mit präklinischer Notfallintubation hinsichtlich Gesamt- und Ersterfolgsrate der Intubation sowie Parameter der Handhabung untersucht. Alle 3 Videolaryngoskope ermöglichten eine vergleichbar gute Sicht auf die Glottisstrukturen, dennoch unterschied sich der Intubationserfolg relevant. Die Intubation war mit dem King Vision mit Führungskanalspatel am schwierigsten (Gesamterfolgsrate bei A. P. Advance, C-MAC PM und King Vision: 96, 97 bzw. 61% (p < 0,001; Ersterfolgsrate: 86, 85 bzw. 48% (p < 0,001). In 5 Fällen beim A. P. Advance und in 4 Fällen beim C-MAC PM war eine Intubation unter direkt laryngoskopischer Sicht mit dem jeweiligen Gerät notwendig. Beim King Vision wurde in 21 Fällen auf ein alternatives Gerät gewechselt. Dementsprechend sollten gerätespezifische Besonderheiten und Limitationen einzelner Videolaryngoskope bei der Ausbildung berücksichtigt werden.

Abstract

Introduction Video laryngoscopy is a valuable technique for endotracheal intubation. In the perioperative period, video laryngoscopes vary both in technical use and intubation success rates. However, in prehospital emergency intubation, the relative performance of video laryngoscopic systems with different blade types is less well studied.

Methods In this prospective, randomized, multicenter study at four German prehospital emergency medicine centers, 168 adult patients requiring prehospital emergency intubation were randomized to one of three portable video laryngoscopes with different blade types (A. P. Advance, C-MAC PM, and channeled-blade King Vision). Primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices.

Results Glottis visualization was comparable in all three devices. Overall intubation success for A. P. Advance, C-MAC PM, and King Vision was 96%, 97%, and 61%, respectively (p < 0.001). Intubation success on the first attempt with A. P. Advance, C-MAC PM, and King Vision was 86%, 85%, and 48%, respectively (p < 0.001). Direct laryngoscopy for successful intubation with the video laryngoscopic device was necessary with the A. P. Advance in 5 patients and with the C-MAC PM in 4 patients. In the King Vision group, 21 patients were intubated with an alternative device.

Discussion During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of three commercially available video laryngoscopes A. P. Advance, C-MAC PM, and King Vision varied markedly. Despite a comparable glottic view, actual intubation was more difficult with the channeled-blade King Vision. Accordingly, device-dependent specifications and limitations should be part of the education.

Schlüsselwörter

Videolaryngoskopie - Notfallmedizin - Intubation - Notarzt - Atemwegsmanagement

Key words

airway management - intubation - emergency medicine - video laryngoscopy
 

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