Facilitation of uninterrupted chest compressions by paramedics: the role of the video laryngoscope [abstract]
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Background. New American Heart Association guidelines emphasize the importance of uninterrupted chest compressions (CCs) in cardiac arrest. Recent studies suggest that direct laryngoscopy (DL) in the field contributes to significant pauses in CCs. The aim of this study was to examine the role of video laryngoscopes (VLs) in facilitating uninterrupted CCs for prehospital cardiac arrest patients. Methods. This was a post hoc analysis from a multisite, prospective, nonrandomized, crossover trial comparing the placement success rates of two VLs (CMAC, Karl Storz; King VISION [KV], King Systems). Inclusion criteria for this analysis consisted of need for advanced airwaymanagement and cardiac arrest as the primary impression. Patient, provider, and clinical demographics were compared between treatment arms. The associations between ongoing CCs and device type, as well as CCs and attempt success, were examined using a chi-square test. An attempt was defined as the tip of the VL blade passing the patient’s lips. Results. There were no demographic differences (provider or patient) between the VL treatment groups. A total of 106 VL attempts (62 CMAC and 44 KV) were made by providers for 97 patients. Of the total attempts, 41.5% were made without stopping CCs, and there was no difference in placement success between attempts with interrupted compressions and continuous compressions (45% vs. 50%; p = 0.62). There was no statistically significant difference between the frequency of KV and CMAC placement attempts with CCs (47.7% vs. 37.1%; p = 0.27). Though the percentage of successful attempts with continued CCs appeared higher in the CMAC group (60.9% vs. 38.1%), the difference did not meet statistical significance (p = 0.13). Conclusion. Overall, CCs were performed on 41% of attempts and more frequently, though not statistically significantly, with KV compared with CMAC. CMAC appeared to have a higher success rate while CCs are ongoing when compared with KV. Though this study did not specifically determine which VL device might better facilitate endotracheal intubation (ETI) with uninterrupted CCs, it did show a large percentage of successful VL intubations without pauses in CC. Future research directly comparing ETI using VL versus DL may establish a permanent place for VL in out-of-hospital cardiac arrest.