A prospective study comparing standard laryngoscopy with the trachview videoscope system for orotracheal intubation

Background

As a technology to facilitate a difficult endotracheal intubation (ETI), the TrachView Videoscope (TrVV) consists of a narrow high-resolution fiberoptic cable whose tip is positioned at the distal end of the endotracheal tube. The image is displayed on a small portable bedside monitor.

Objective

To determine the reported ease of use of the TrVV and the accompanying percent improvement in assessment of the glottic opening (POGO) score when operated by individuals of varied levels of ETI experience.

Methods

The study was conducted in two phases using a mannequin model during an airway workshop for first-year, second-year and third-year (R1, R2, R3) emergency medicine (EM) residents with ETI experience and first-year and second-year medical students with no ETI experience. In phase 1, after a 10-min demonstration of the TrVV, EM residents assessed the POGO score using direct laryngoscopy (DL) and sequentially compared it with their observed POGO score using the TrVV. Phase 2 consisted of a crossover study with the medical students who were randomized into two groups: a group first instructed in DL and a second first instructed in TrVV. The students were given a 10-min demonstration of each technique and had two opportunities to return the demonstration. The POGO scores noted by the students were then recorded for each technique. The groups were then crossed and the process was repeated. Additional information collected from study subjects included reported ease of use of the TrVV and improvement in ETI success.

Results

In Phase 1, the overall median POGO score for DL was 50%, and the median POGO score for TrVV was 100% (P < 0.001). The median differences in POGO scores (TV – DL) were: 50% for R1s (n = 4), 50% for R2s (n = 10), and 25% for R3s (n = 11). Of these, 86% (n = 24) reported that the TrVV was 'easy' to use and 11% (n = 3) were undecided. Only one reported it to be 'difficult' to use. Most (82%; n = 23) reported that the TrVV improved their ETI attempt, but 14% (n = 4) reported no difference. In Phase 2, the overall median TrVV and DL POGO scores (n = 34) were 75% and 25%, respectively (P = 0.004). The median difference in POGO scores (TV – DL) for the two groups were: 75% for Group 1 (DL first) and 50% for Group 2 (TrVV). Of all participants, 68% (n = 25) ranked the TrVV as 'easy', 22% (n = 8) were undecided, and 11% (n = 4) ranked the TrVV as 'difficult' to use. Meanwhile, 57% (n = 21) reported that it improved their ETI attempts, 27% (n = 10) reported no difference, and 11% (n = 4) reported 'more difficulty'.

Conclusion

The Trachview Videoscope can significantly improve the POGO score assessment over direct laryngoscopy and, in the laboratory setting, most operators report it to be an easy to use technique that improves their intubation success, regardless of level of experience.