Transcript Journal Club Presentation

A Mannequin Study of Intubation with the
AP
Advance and GlideScope Ranger
Videolaryngoscopes
and the Macintosh Laryngoscope
Elisa Brunetto BSN, RN, SRNA
Journal Club
Winter 2012
Brewer, E.J., Cata, J., Dalton, J.E., Doyle, D.J., Hodd, J.A., James, M.
& Sessler, D.I. (2011). A mannequin study of intubation with
the AP Advance and GlideScope Ranger Videolaryngoscopes
and the Macintosh Laryngoscope. AANA, 111(13), 791-800.
Introduction
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October 2011 AANA journal
Conducted at Cleveland Clinic
IRB approved
Clinicians who “might” intubate during their clinical
practice were eligible
– Group 1: medical students and clinicians with little to no
experience
– Group 2: Paramedical and medical staff with experience
using MAC blades
– Group 3: anesthesia provides with GlideScope and MAC
blade experience
Purpose
• Assess if the AP Advance (APA) takes the same
amount of time as a MAC blade to intubate
normal airways and a GlideScope with difficult
airways on a mannequin
Background
• AP advance
– Videolaryngoscope
– Has interchangeable blades (Traditional MAC blade
or difficult airway blade with increased curvature and
channel to guide tube into the airway)
Background
• MAC Blade
– Chosen because it is ubiquitous and highly effective
in normal airways
– First blade chosen for beginners
• Glidescope
– Selected for its proved efficacy and ease of use over
other alternative airway techniques
Study
• Each participate received the manufactures
instructions for the device as well as a demo
• Participants were then allowed to practice each
device on a normal airway mannequin
Study
• Envelope blinded participates to scope and
airway order until the start of the study
• Timing started when participate first touched
airway equipment
Study
• Failed airway
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Unrecognized esophageal intubations
Abandoned procedures
Intubations that took greater then 120 sec
Intubations that required more then 3 attempts
Study
• Failed attempt
– Removal of airway equipment without successful
intubation
– Number of attempts and failed intubations was
recorded
Study
• Potential damage
– Assessed by comparing number of misdirected
advances of the ET tube
• Ease of glottic view
– Measured by recording time required by participants
to say they had the best view
– Time required to place tube after view obtained was
recorded
Study
• Participants
– Asked to recommend device for use in normal
airway, difficult airway, single device for all
intubations
– Rate GlideScope and AP Advance on portability,
light source, picture quality, and position of screen
Statistical Analysis
• Stratified Cox regression model was used for
each airway
– Based on adjusted categories on participants
experience
– Enrolled 90 participants which was 50% more then
previous studies using the AP Advance
– Significance at >0.8
Results
• Normal airway mannequin
– Intubation times were longer with GlideScope then
other two devices
– Intubation time for AP advance was 22 sec and 23
sec for the glideScope
– AP advance had one failure, GlideScope 5, MAC
blade 3
– AP advance 7 times more likely to have a better view
more quickly
Results
• Difficult airway
– AP Advance required least time followed but
GlideScope and finally MAC blade
– 20 sec for AP advance vs 59 sec GlideScope
– AP advance had no failures, GlideScope 30 (33%),
MAC blade 33 (37%)
Results
• AP Advance caused less damage to glottis
• 82% of users would chose the AP Advance if
they had only one device for use
• Preferred screen position and portability
Strengths
• Mannequin used provided that the same airway
was used for each device and practitioner
• Device that was to be used was blinded to
participants
• Participants all received an opportunity to
practice with the device before using in the
study
Weakness
• Mannequins fail to have the same texture of
human tissues
• Didn’t take into account cost for devices
– GlideScope 11,000, $15 per blade
– AP Advance 7500, $45 per blade
• To many different skill levels were used
– Could have contributed to the high number of failed
intubations due to the novice skill set
Implications to Practice
• Use the AP Advance when available at facilities
• Encourage facilities to purchase AP Advance if
budgeting allows