Video rigid flexing laryngoscope (RIFL) vs Miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: a simulation study

Lukasz Szarpak, Andrzej Kurowski, Lukasz Czyzewski, Antonio Rodríguez-Núñez
American Journal of Emergency Medicine 2015, 33 (8): 1019-24

OBJECTIVES: Endotracheal intubation (ETI) is an essential resuscitation procedure in children. Video laryngoscopes have been developed to avoid intubation failures in a variety of scenarios, including cardiopulmonary resuscitation. We hypothesized that the video laryngoscope RIFL (AI Medical Devices, Inc, Williamston, MI) offers advantages in the ETI of a pediatric manikin while performing chest compressions (CCs).

METHODS: Randomized nonblinded crossover simulation trial conducted among 132 paramedics with no prior experience with RIFL. Each participant performed intubations with Miller (MIL; Mercury Medical, Clearwater, FL) laryngoscope and RIFL in a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) in 3 airway scenarios: (a) normal airway at rest (without concomitant CC), (b) normal airway with mechanically controlled CC, and (c) difficult airway with concomitant CC. The primary outcome was the time to intubation, and secondary one was the success of the intubation attempt.

RESULTS: In the manikin at rest with normal airway, nearly all participants performed successful ETI both with MIL and RIFL, with similar intubation times. However, in the other scenarios (normal and difficult airway with uninterrupted CC), the results with RIFL were significantly better than with MIL (P < .05) for all the analyzed variables (success of first attempt, overall success rate, time to intubation, Cormac-Lehane grade, dental compression, and easy of intubation scores).

CONCLUSIONS: In simulated child arrest scenarios with normal/difficult airway conditions and with concomitant mechanical CC, paramedics performed better with the RIFL video laryngoscope than with the standard MIL.

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