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Endotracheal intubation may be needed in critically ill patients in the prehospital setting, where difficult conditions may be encountered. The patient may be lying on the ground, thus complicating direct laryngoscopy as the operator's visual axis cannot be properly aligned with the patient's oral-pharyngeal-tracheal axis. The posture sitting cross-legged ("Lotus" position) at the head of the patient may allow an easier alignment of the visual axes due to a lower operator's head position and more stability. We compared the impact of the "Lotus" position with free positioning of the operator for direct laryngoscopy on intubation first pass success rate among novice operators.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Free positioning | Active Comparator |
| |
| Sitting cross-legged ("Lotus" position) | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Free positioning | Procedure | Participants are not given instructions on how to position for intubation using direct laryngoscopy. |
|
| Measure | Description | Time Frame |
|---|---|---|
| First Pass Success rate | In percentage, defined as achieving successful ETI on the initial attempt. An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt. | Periprocedural |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Intubation | Time in seconds from blade insertion at the dental arch to successful ventilation. A maximum of 60 seconds was allowed per ETI attempt. | Periprocedural |
| Time to Intubation for the first intubation attempt alone |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Laurent SUPPAN, PD Dr | University Hospital, Geneva | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hôpitaux Universitaires de Genève | Geneva | Canton of Geneva | 1205 | Switzerland |
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| Sitting cross-legged ("Lotus" position) | Procedure | Participants are requested to sit cross-legged for intubation using direct laryngoscopy. |
|
Time in seconds from blade insertion at the dental arch to adequate ventilation, ruling out first-attempt failures. A maximum of 60 seconds was allowed per ETI attempt.
| Periprocedural |
| Number of intubations attempts | An ETI attempt was counted since the laryngoscope blade was inserted at the dental arch, regardless of whether tracheal tube placement was attempted or not. ETI was considered successful when adequate ventilation was confirmed by chest elevation. The number of intubation attempts were limited to three, with a time limit of 60 seconds allowed per attempt. | Periprocedural |
| Cormack and Lehane (CL) score | For each attempt, the view of the larynx was assessed by the participant using the Cormack-Lehane score. | Periprocedural |
| Percentage Of Glottis Opening (POGO) score | For each attempt, the percentage of glottis opening was assessed by the participant, using the POGO score. | Periprocedural |
| Subjective assessments | Perceived difficulty was appraised using a 5-point Likert scale ranging from "Totally Agree" to "Totally Disagree". | Periprocedural |