Performance of emergency physicians utilizing a video-assisted semi-rigid fiberoptic stylet for intubation of a difficult airway in a high-fidelity simulated patient: a pilot study

Abstract

Background: This study was designed to evaluate emergency physician success and satisfaction using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS), during a simulated difficult airway scenario.

Findings: Emergency physicians (EPs) of all levels were first shown a brief slide show and three example videos, and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed in a c-collar and set to simulate an apneic patient with an edematous tongue and trismus. Each EP was given up to three timed attempts with each technique. They rated their satisfaction with the CVS, usefulness for their practice, and the effectiveness of the tutorial. Direct laryngoscopy had a 65% success rate on the first attempt, 20% on the second, and 15% required three or more. The CVS had a 100% success rate with a single attempt. Average time for independent DL attempts was 43.41 s (SD = ±26.82) and 38.71 s (SD = ±34.14) with CVS. Cumulative attempt times were analyzed and compared (DL = 74.55 ± 68.40 s and CVS = 38.71 ± 34.14 s; p = 0.028). EPs rated their satisfaction with, and usefulness of, the CVS as ≥6 out of 10.

Conclusion: Emergency physicians were able to successfully intubate a simulated difficult airway model on the first attempt 100% of the time. Emergency physicians were satisfied with the CVS and felt that it would be useful in their practice.

Figure 1

The Clarus Video System (Clarus Medical, Minneapolis, MN).

Figure 2

Endotracheal tube in position over the CVS.

Figure 3

Views as seen on the CVS screen: A. View of the larynx of the mannequin with ETT loaded on the CVS. B. View of the mannequin’s trachea after positioning the end of the stylet through the vocal cords. C. View of the ETT passing through the cords as it is advanced off of the CVS. D. Confirmation of ETT placement by viewing the larynx with the CVS.