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Tracheal intubation using videolaryngoscopy may be required in the prehospital setting, where airway management presents unique technical and logistical challenges. Intubation may be hard 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 aim to compare the impact of a freely realized videolaryngoscopy sequence 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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Free use of videolaryngoscopy | Active Comparator |
| |
| Direct Laryngoscopy-to-VideoLaryngoscopy sequence | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Direct Laryngoscopy-to-VideoLaryngoscopy sequence | Procedure | Participants will proceed with a double intubation technique sequence, first performing an initial direct laryngoscopy without looking at the video screen until they reached the epiglottis, then performing an indirect lryngoscopy for intubation. |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Intubation | Time in seconds from blade insertion at the dental arch to adequate tracheal tube placement through the vocal cords, confirmed by the C-MAC video recording. A maximum of 60 seconds was allowed per ETI attempt. The maximum number of ETI attempts was limited to 3. | Periprocedural |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Intubation for the first intubation attempt alone | Time in seconds from blade insertion at the dental arch to adequate tracheal tube placement through the vocal cords, confirmed by the C-MAC video recording. A maximum of 60 seconds was allowed per ETI attempt. | Periprocedural |
| First Pass Success rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| PD Dr Laurent Suppan | University Hospital, Geneva | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hôpitaux Universitaires de Genève | Geneva | Canton of Geneva | 1205 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40596822 | Derived | Cibotto C, Pasquier M, Beysard N, Rouyer F, Grosgurin O, Bourgeois L, Erriquez E, Braun E, Gartner BA, Desmettre T, Suppan L. Assessment of prehospital tracheal intubation technique using initial direct laryngoscopy during videolaryngoscopy: randomized controlled simulated trial. BMC Emerg Med. 2025 Jul 1;25(1):112. doi: 10.1186/s12873-025-01266-0. |
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| Free use of videolaryngoscopy | Procedure | Participants are free to use of the videolaryngoscope as they intended |
|
Intubation first pass success rate, in percentage. |
| Periprocedural |
| Number of intubations attempts | An ETI attempt was defined as the insertion of the laryngoscope blade at the dental arch, regardless of whether tracheal tube placement was attempted. A maximum of 60 seconds was allowed per ETI attempt. The maximum number of ETI attempts was limited to 3. More than 3 attempts, it was considered as failed. | Periprocedural |
| Time to Ventilation | Time in seconds from blade insertion at the dental arch to successful ventilation confirmed by chest elevation. A maximum of 60 seconds was allowed per ETI attempt. | Periprocedural |
| Subjective assessments | Subjective assessments, including perceived difficulty (Question 1 - I found intubation easy. Question 2 - I felt comfortable intubating this way. Question 3 - I think the use of the VL was adequate to intubate OR I think the sequenced use of the VL helped me intubate. Question 4 - In a future similar clinical situation, I will make the same use of the VL to intubate OR I think doing a direct laryngoscopy before looking at the screen allows for faster intubation than doing an indirect laryngoscopy only. Question 5 - In a future similar clinical situation, I will make a different use of the VL to intubate OR In a future similar clinical situation, I will make the same use (DL-VL) of the VL to intubate. Question 6 - In a future similar clinical situation, I will make a different use (VL only) of the VL to intubate.), were appraised using a 5-point Likert scale ranging from "Totally Agree" to "Totally Disagree". | Periprocedural |