Impact of VieScope® on first-attempt success during simulated COVID-19 patients intubation: A randomized cross-over simulation trial

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope(®) and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGPs). METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieScope(®) and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random. RESULTS: In Scenario A, time to intubation using VieScope(®) and Macintosh laryngoscope amounted to 35.3 (IQR; 32–40) seconds and 35.8 (IQR: 30–40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngoscope (100% vs. 94.6%). In scenario B, intubation with the VieScope(®), compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001). CONCLUSION: Our analysis suggests that the use of a VieScope(®) compared to Macintosh laryngoscope in difficult airway intubation performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.