Utility of the Pentax-AWS without interruption of chest compression: comparison of the Macintosh laryngoscope with the Pentax-AWS in manikin model.

BACKGROUND: Emergency airway management in suboptimal conditions can result in difficulties in tracheal intubation. The video laryngoscope (Pentax-AWS) has potential advantages during difficult tracheal intubations. According to the 2005 guidelines for cardiopulmonary resuscitation (CPR), all rescuers should minimize interruption of chest compressions. Our hypothesis is that tracheal intubation using the Pentax-AWS is possible without interruption of chest compressions. We tested this using tracheal intubation performed by less experienced medical personnel in a manikin model.

METHODS: Thirty-two less experienced (<10 tracheal intubations) medical interns performed intubation using the Pentax-AWS and the Macintosh laryngoscope in an ALS simulator (Laerdal, Stavanger, Norway) in each of three scenarios. The three scenarios were: (1) normal airway without chest compression, (2) normal airway with continuous chest compression, and (3) difficult airway with continuous chest compression. The success rate, time required to complete tracheal intubation and to visualize vocal cords, POGO (percentage of glottic opening) score, dental compression and the ease of intubation were recorded.

RESULTS: All participants performed successful intubation with the Pentax-AWS in the three scenarios. In the two continuous chest compression scenarios (scenarios 2 and 3), the success rate was significantly higher with the Pentax-AWS than with the Macintosh laryngoscope.

CONCLUSIONS: The Pentax-AWS was an effective tool for endotracheal intubation during chest compression performed by less experienced medical personnel in a manikin model simulating cardiac arrest, both under conditions of normal and difficult airways.