Abstract
Purpose
We sought to establish the clinical utility of the Pentax-AWS Airway Scope® (AWS) when used by paramedics to intubate the trachea, and to evaluate whether their performance was influenced by previous clinical experience with the Macintosh laryngoscope (ML).
Methods
Twenty paramedics attempted tracheal intubation using the AWS in five patients each in the operating room. We recorded the success rate, the number of intubation attempts, and the time for intubation and adverse events, and compared these based on the paramedics’ previous clinical experience with the ML. Ten paramedics had no prior clinical experience of the ML (group A) and 10 had used it on more than 30 occasions (group B).
Results
The intubation success rate was 99 % (99/100). Notably, 96 % (47/49) of intubations were achieved on the first attempt by the inexperienced paramedics in group A, compared with 64 % (32/50) by the experienced paramedics in group B (p = 0.0001). The time to intubation (mean ± SD) was significantly shorter in group A than in group B (37 ± 24 vs. 48 ± 21 s, p = 0.002). There were marked variations in the times taken to intubate, but no apparent improvement as the intubators gained experience between their first and fifth cases. No complications were encountered in either group.
Conclusion
We found that paramedics could achieve a high tracheal intubation success rate using the AWS independent of previous airway management experience. Better intubation performance with the AWS was observed in paramedics without clinical experience with the ML.
Similar content being viewed by others
Abbreviations
- ML:
-
Macintosh laryngoscope
- AWS:
-
Pentax-AWS Airway Scope®
- OR:
-
Operating room
- ID:
-
Internal diameter
References
Sakles JC, Rodgers R, Keim SM. Optical and video laryngoscopes for emergency airway management. Intern Emerg Med. 2008;3:139–43.
Koyama J, Aoyama T, Kusano Y, Seguchi T, Kawagishi K, Iwashita T, Okamoto K, Okudera H, Takasuna H, Hongo K. Description and first clinical application of AirWay Scope for tracheal intubation. J Neurosurg Anesthesiol. 2006;18:247–50.
Sadamori T, Kusunoki S, Ishida M, Otani M, Tanigawa K. Video laryngoscopy for emergency tracheal intubation during chest compression. Resuscitation. 2008;77:155–6.
Sadamori T, Kusunoki S, Otani T, Ishida M, Masuda R, Tamura T, Takeda T, Tsumura R, Shokawa T, Kondo T, Sakai H, Iwasaki Y, Yamanoue T, Hirohashi N, Tanigawa K. Airway Scope for emergency intubations: usefulness of a new video-laryngoscope. Hiroshima J Med Sci. 2008;57:99–104.
Maharaj CH, Higgins BD, Harte BH, Laffey JG. Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy—a manikin study. Anaesthesia. 2006;61:469–77.
Nasim S, Maharaj CH, Malik MA, O’Donnell J, Higgins BD, Laffey JG. Comparison of the Glidescope and Pentax AWS laryngoscopes to the Macintosh laryngoscope for use by advanced paramedics in easy and simulated difficult intubation. BMC Emerg Med. 2009;9:9.
Enomoto Y, Asai T, Arai T, Kamishima K, Okuda Y. Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study. Br J Anaesth. 2008;100:544–8.
Maharaj CH, Costello JF, Higgins BD, Harte BH, Laffey JG. Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia. 2006;61:671–7.
Miki T, Inagawa G, Kikuchi T, Koyama Y, Goto T. Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: a manikin study. Acta Anaesthesiol Scand. 2007;51:1378–81.
Hirabayashi Y, Seo N. Tracheal intubation by non-anesthesia residents using the Pentax-AWS airway scope and Macintosh laryngoscope. J Clin Anesth. 2009;21:268–71.
Liu L, Tanigawa K, Kusunoki S, Tamura T, Ota K, Yamaga S, Kida Y, Otani T, Sadamori T, Takeda T, Iwasaki Y, Hirohashi N. Tracheal intubation of a difficult airway using Airway Scope, Airtraq and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel. Anesth Analg. 2010;110:1049–55.
The Ministry of Health, Labour and Welfare. Preclinical and clinical training of paramedic for airway management using tracheal intubation. No. 0323049. 2004.3.23. http://www.qqzaidan.jp/sinpai/notice_kourou/040323_0323049/kourou067.pdf. Accessed 14 Dec 2014.
Okazaki Y, Kusunoki S, Kawamoto M. Out-of-hospital tracheal intubation practice by advanced level ambulance crews and re-education program for skill retention: survey of emergency life saving technicians (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2011;60(6):757–62.
The Emergency Medical Activities Development Promoting panel, the second Medical Control working group, 2010.10.13. http://www.fdma.go.jp/html/intro/form/pdf/mc_sagyoubukai/221013/haifushiryo.pdf. Accessed 14 Dec 2014.
Garza AG, Gratton MC, Coontz D, Noble E, Ma OJ. Effect of paramedic experience on orotracheal intubation success rates. J Emerg Med. 2003;25:251–6.
Stewart RD, Paris PM, Pelton GH, Garretson D. Effect of varied training techniques on field endotracheal intubation success rates. Ann Emerg Med. 1984;13:1032–6.
Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TL, Bottiger BW, Drajer S, Lim SH, Nolan JP, Advanced Life Support Chapter Collaborators. Part 8: Advanced life support. 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010;122(16 suppl 2):S345–S421.
Suzuki A, Toyama Y, Katsumi N, Kunisawa T, Sasaki R, Hirota K, Henderson JJ, Iwasaki H. The Pentax-AWS® rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia. 2008;63:641–7.
Hirabayashi Y, Seo N. Airway Scope: early clinical experience in 405 patients. J Anesth. 2008;22:81–5.
The Fire and Disaster Management Agency, and the Ministry of Health, Labour and Welfare. Strengthening of the Medical Control System on the airway management with use of tracheal tube performed by paramedics. Fire Defense and Emergency No. 217, Medical Policy Direction No. 0801-3, August 1, 2011. http://www.fdma.go.jp/emergency_rescue/kyukyu_kyujo_tuchi/2011/20110801-1.pdf. Accessed 14 Dec 2014.
The Fire and Disaster Management Agency, and the Ministry of Health, Labour and Welfare. Strengthening of the Medical Control System on the airway management with use of tracheal tube performed by paramedics. Fire Defense and Emergency No. 217, Medical Policy Direction No. 0801-3, August 1, 2011:104-110. http://www.fdma.go.jp/html/intro/form/pdf/kinkyugyoumu_kentokai/houkoku/4.pdf. Accessed 14 Dec 2014.
Acknowledgments
The authors give special thanks to Drs. Masashi Kawamoto and Hideki Fukuda at Hiroshima University Hospital, Keiichi Tada at Hiroshima City Hospital, Miwako Nakao at Hiroshima Prefectural Hospital, and Masaki Senami at Onomichi General Hospital for their assistance with data collection. This study was supported by a Science and Technology Promotion Grant 2010 of the Fire and Disaster Management Agency, Japan. A portion of our findings was presented in the report of the Emergency Medical Activities Development promoting panel (Kyukyugyoumu Koudoka Suishin Kentoukai) meeting in 2011 [21].
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ota, K., Sadamori, T., Kusunoki, S. et al. Influence of clinical experience of the Macintosh laryngoscope on performance with the Pentax-AWS Airway Scope®, a rigid video-laryngoscope, by paramedics in Japan. J Anesth 29, 672–677 (2015). https://doi.org/10.1007/s00540-014-1960-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-014-1960-1