Assessment of prehospital tracheal intubation technique using initial direct laryngoscopy during videolaryngoscopy : randomized controlled simulated trial

Article Article scientifique Article Assessment of prehospital tracheal intubation technique using initial direct laryngoscopy during videolaryngoscopy : randomized controlled simulated trial eng 2025-07-01 author Cibotto Cédric 0009-0002-7281-5914 Division of Anaesthesiology, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. cedric.cibotto@hug.ch.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. cedric.cibotto@hug.ch.,DMA Département de Médecine Aiguë, Hôpitaux Universitaires de Genève (HUG), Service d'Anesthésiologie, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Suisse. cedric.cibotto@hug.ch. 751683 author Pasquier Mathieu 0000-0003-0042-5909 Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, 1011, Switzerland. author Beysard Nicolas 0000-0003-3561-1250 Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, 1011, Switzerland. author Rouyer Frédéric Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 885902 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Grosgurin Olivier 0000-0001-6233-6579 Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 503200 Département de médecine (DEMED) author Bourgeois Laurent College of Higher Education in Ambulance Care, ESAMB - École Supérieure de Soins Ambulanciers, Geneva, Switzerland. 106153 author Erriquez Elio Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. author Braun Ely Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 403361 author Gartner Birgit Andrea 0000-0003-0726-3201 Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 89644 Birgit Gartner author Desmettre Thibaut Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 412936 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Suppan Laurent Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland. 505697 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) 112 10.1186/s12873-025-01266-0 40596822 1471-227X PMC12217279 https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-025-01266-0 Background: In critically ill patients, tracheal intubation may be required in the prehospital setting, where airway management presents unique technical and logistical challenges. While videolaryngoscopy has emerged as a potential alternative to direct laryngoscopy by providing a better and easier visualization of the glottis, the improved view of anatomical structures does not necessarily correlate with successful tracheal tube placement. Intubation may be harder because novice providers performing videolaryngoscopy may only look at the screen and only obtain a two-dimensional representation of the patient's airways. By directly visualizing the airways, these providers may obtain a better 3D apprehension and an improved mental visualization of the patient's anatomy. We compared the impact of an unrestricted videolaryngoscopy use with a sequence consisting in direct visualization of the airway followed by videolaryngoscopy ("Direct Laryngoscopy-to-VideoLaryngoscopy sequence" or "DL-VL sequence") on time to intubation among novice providers. Methods: This was a parallel group simulated randomized controlled superiority trial. Participants were medical students or junior residents with an experience of less than 10 intubations. After a presentation and workshop on direct laryngoscopy and videolaryngoscopy, participants were randomized in two groups. In the control group, participants were free to use of the videolaryngoscope as they intended. In the other group (DL-VL sequence), participants were told to perform an initial direct laryngoscopy without looking at the video screen until they reached the epiglottis. All intubations were conducted in a simulated prehospital environment, with a high-fidelity manikin placed supine on the floor. Each participant performed three intubations of increasing levels of difficulty. The primary outcome was the time to intubation. Secondary outcomes included first-pass success, time to ventilation, and number of intubation attempts. The chi-squared test was used to compare categorical variables while the t-test was used to compare continuous variables. Results: Time to intubation was shorter in the control group (22±8 s vs. 27±11 s, p < 0.001). This difference was consistent in all levels of difficulties. First-pass success rates were similar (99/111, 89% in the control group vs. 85/105, 81%, p = 0.089). Time to ventilation was significantly shorter in the control group (37±9 vs. 41±11 s, p = 0.008). The mean number of intubation attempts was similar between groups (p = 0.231). Conclusion: In this simulated study among novice providers, direct airway visualization prior to videolaryngoscopy did not improve time to intubation or to ventilation. Trial registration: ClinicalTrials.gov, Registration Number: NCT06918717, registered on April 8th, 2025. Retrospectively registered. Advanced airway management Direct laryngoscopy Prehospital Tracheal intubation Videolaryngoscopy Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false https://yareta.unige.ch/archives/a03dcc6c-08dc-4d92-8b81-b5766ffdb631 BMC emergency medicine 25 1 b5133a1d-0a97-4586-8012-d840a543e5a2 Article (Published version) Public Article_scientifique_from_unpaywall.pdf 1219114 application/pdf CC BY-4.0 a6a3169bf5508e736a79ddefeca80886e801126b4148eac3d38dd291748d9e0a 58360b33-f38e-4c93-98f8-e2060636099e Supplemental data Public 12873_2025_1266_MOESM1_ESM.docx 242671 application/vnd.openxmlformats-officedocument.wordprocessingml.document a29dbcb99ab3f05df8bdeb67b243a13b4bf48c5de0ef06e455d2eda67eff3db6 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Assessment of prehospital tracheal intubation technique using initial direct laryngoscopy during videolaryngoscopy : randomized controlled simulated trial	BMC emergency medicine			2025	48	107

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Bourgeois, Laurent