Abstract
Background : The purpose of this study was to evaluate the performance of orotracheal intubation with the Millerlaryngoscope compared with the Airtraq laryngoscope by emergency and pediatric physicians wearing CBRN-PPEtype III on infant manikins with conventional airway. We hypothesized that in this situation, the orotracheal intubationwith the Airtraq laryngoscope would be faster and more effective than with the Miller laryngoscope.Methods : This was a prospective, randomized, crossover, single-center study who recruited emergency departmentphysicians on a voluntary basis. Each physician performed a total of 20 intubation trials while in CBRN-PPE with thetwo intubation techniques, Miller and Airtraq. Intubations by each airway device were tested over ten consecutiveruns. The order of use of one or the other devices was randomized with a ratio of 1:1. The primary endpoint wasoverall orotracheal intubation success.Results : Fifty-five emergency and pediatric physicians were assessed for eligibility. Forty-one physicians wereincluded in this study and 820 orotracheal intubation attempts were performed. The orotracheal intubation successrate with the Airtraq laryngoscope was higher than with the Miller (99 % vs. 92 %;p-adjusted<.001). The orotrachealintubation and glottis visualization times decreased with the number of attempts (p<.001). The median orotrachealintubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope (15 s vs. 20 s;p-adjusted<.001). The median glottis visualization time with the Airtraq laryngoscope and with the Miller laryngoscope werenot different (6.0 s vs. 7.5 s;p-adjusted=.237). Thirty-four (83 %) physicians preferred the Airtraq laryngoscope versus6 (15 %) for the Miller (p-adjusted<.001).Discussion : For tracheal intubation by physicians wearing CBRN-PPE during infant resuscitation simulation, weshowed that the orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Millerlaryngoscope and that orotracheal intubation time with the Airtraq laryngoscope was lower than with the Millerlaryngoscope.