Effect of real-time carbon dioxide sensing stylet-assisted endotracheal intubation: A case-crossover manikin simulation study

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2025-05-26 DOI:10.1016/j.ajem.2025.05.047

Yoonjic Kim MD , Yoon Ha Joo PhD , Ki Hong Kim MD, PhD , Dong Hyun Choi MD , Hyun Jeong Kang MS , Ki Jeong Hong MD, PhD , Kyoung Jun Song MD, PhD , Sang Do Shin MD, PhD

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引用次数: 0

Abstract

Background

Endotracheal intubation is an important emergency procedure, especially in critical care settings. Capnography-guided intubation (CGI) is a technology that may enhance procedural efficiency. This study aimed to compare the effectiveness of CGI with conventional intubation (CI) using a manikin simulation.

Methods

A case-crossover manikin simulation study was conducted with three clinical scenarios: normal airway, cervical immobilization, and cardiopulmonary resuscitation. A CO2-exhalation simulation manikin was developed for this purpose. Participants were randomly assigned to perform CGI or CI first, followed by the alternative method. The primary outcome was the first-attempt success rate, and the secondary outcome was the procedure time of intubation. A linear mixed-effects model with a random effect for each subject was applied.

Results

A total of 40 participants were enrolled, and 20 in each study group. The first-attempt success rate was higher with CGI than CI across all clinical situations, with statistically significant differences in the normal airway and cervical immobilization settings. Specifically, for the normal airway, the success rate was 40 (100.0 %) for CGI vs. 33 (82.5 %) for CI [abs diff: 17.5 %, 95 % CI: 5.7 %–29.3 %]; for cervical immobilization, 39 (97.5 %) vs. 32 (80.0 %) [abs diff: 17.5 %, 95 % CI: 4.2 %–30.8 %]; and for cardiopulmonary resuscitation, 40 (100.0 %) vs. 38 (95.0 %) [abs diff: 5.0 %, 95 % CI: −1.8 %-11.8 %]. The intubation time was shorter with CGI in the normal airway and cervical immobilization scenarios. The median [interquartile range (IQR)] time for normal airway was 23.5 (19.2–28.4) sec for CGI vs. 31.6 (22.2–59.7) sec for CI, and for cervical immobilization, 24.4 (20.4–30.8) sec for CGI vs. 28.6 (22.6–56.9) sec for CI. In cardiopulmonary resuscitation, the median [IQR] was 23.1 (19.6–31.4) sec for CGI vs. 25.1 (18.6–32.4) sec for CI.

Conclusion

In the manikin-based randomized crossover simulation, CGI achieved a higher first-attempt success rate and shorter intubation time than CI in the normal airway and cervical immobilization scenarios.

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实时二氧化碳传感型辅助气管插管的效果：一项病例-交叉模型模拟研究

背景：气管插管是一项重要的急诊程序，特别是在重症监护环境中。导管造影引导下插管（CGI）是一种可以提高手术效率的技术。本研究旨在通过人体模拟比较CGI与传统插管（CI）的有效性。方法采用正常气道、颈椎固定和心肺复苏三种临床情景进行病例交叉模拟研究。为此开发了一个二氧化碳呼出模拟人体。参与者被随机分配首先执行CGI或CI，然后是另一种方法。主要观察指标为首次插管成功率，次要观察指标为插管时间。采用随机效应的线性混合效应模型。结果共入组40例，每个研究组20例。在所有临床情况下，CGI的首次尝试成功率高于CI，在正常气道和颈椎固定情况下具有统计学意义。具体来说，对于正常气道，CGI的成功率为40 (100.0%)，CI的成功率为33 (82.5%)[abs diff: 17.5%, 95% CI: 5.7% - 29.3%]；对于颈椎固定,39(97.5%)和32 (80.0%)(abs diff: 17.5%, 95%置信区间CI: 4.2% - -30.8%);心肺复苏，40例（100.0%）对38例（95.0%）[腹肌差异：5.0%,95% CI: - 1.8% - 11.8%]。在正常气道和颈椎固定情况下，CGI插管时间较短。正常气道的中位数[四分位间距（IQR）]时间为CGI组23.5（19.2-28.4）秒，CI组31.6（22.2-59.7）秒；颈椎固定组CGI组24.4（20.4-30.8）秒，CI组28.6（22.6-56.9）秒。在心肺复苏中，CGI的中位[IQR]为23.1（19.6-31.4）秒，CI为25.1（18.6-32.4）秒。结论在基于人体模型的随机交叉模拟中，在正常气道和颈椎固定情况下，CGI比CI具有更高的首次尝试成功率和更短的插管时间。

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.