Videolaringoscopy beyond Conventional Endotracheal Intubation in HEMS: A Real Flight Simulation

Author(s): Facchetti G, Gyra A, Angeletti C, Masedu F, Molineris E, Franchi D, Introzzi L, Lucchelli M, Molesi A, Marinangeli F, Bucci V†

Background: In pre-hospital setting, airway management may be required during hems transportation, when patients deteriorate while en route. Our primary objective was to assess whether in-flight indirect laryngoscopy in frontal right-lateral sitting position (FP) of the operator, is such effective as traditional indirect laryngoscopy methods onshore, considering, also, the association of success rate with influencing flight factors (flying, devices, position, comfort VAS, Lumen VAS).

Methods: This observational prospective study, aimed to estimate the success rate of in-flight FP indirect laryngoscopy intubation. The study conducted on an AW 169 helicopter (©Leonardo Company, Italy) equipped with transversal stretcher, during steady flight. Indirect laryngoscopy devices (GlideScope Ranger and AirTraq) were used on a HAL® manikin (Accurate, Gaumard® Scientific Company,Inc) with cervical collar.

Results: All of the FP intubations with both devices were successful after two attempts maximum. The mean time for intubation was slightly greater using the Glide Scope Ranger (mean 45.4 ± 32.2”) compared to AirTraq (mean 34.8 ± 26.7”).

Conclusions: Both AirTraq and GlideScope Ranger used in in-flight FP guarantee a comparable level of effectiveness to traditional onshore method with 100% successful rate of intubation, Airtraq seems not been affected by Lumen, indicating that in this specific contest it guarantees a high visualisation regardless the light conditions. On the other hand, the FP results effective using AirTraq in both conditions.