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. 2021 Sep 1;11(3):90-98.
doi: 10.6705/j.jacme.202109_11(3).0002.

Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study

Mustafa Kürşat Ayrancı  1 , Kadir Küçükceran  1 , Zerrin Defne Dündar  1
Affiliations

Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study

Mustafa Kürşat Ayrancı et al. J Acute Med. .

Abstract

Background: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone.

Methods: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I2 was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate.

Results: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I2 < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460).

Conclusions: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.

Keywords: coagulopathy; meta-analysis; prothrombin complex concentrate; trauma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. The study flow card.
CPR: cardiopulmonary resuscitation; DL: direct laryngoscopy; VL: video laryngoscopy; w/o: without.
See this image and copyright information in PMC

References

    1. Benoit JL, Gerecht RB, Steuerwald MT, et al. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation. 2015;93:20-26. doi:10.1016/j.resuscitation.2015.05.007 - DOI - PubMed
    1. Truszewski Z, Szarpak L, Czyzewski L. A comparison of the ETView VivaSight SL against a fiberoptic bronchoscope for nasotracheal intubation of multitrauma patients during resuscitation. A randomized, crossover, manikin study. Am J Emerg Med. 2015;33:1097-1099. doi:10.1016/j.ajem.2015.04.078 - DOI - PubMed
    1. Szarpak L, Truszewski Z, Czyzewski L, et al. A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med. 2016;34:1338-1341. doi:10.1016/j.ajem.2015.11.060 - DOI - PubMed
    1. Panchal AR, Berg KM, Hirsch KG. American heart association focused update on advanced cardiovascular life support: Use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest: An update to the american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2019;2019;140:e881-e894. doi:10.1161/CIR.0000000000000732 - DOI - PubMed
    1. Soar J, Nolan JP, Böttiger BW. Adult advanced life support section collaborators. European resuscitation council guidelines for resuscitation 2015: Section 3. Adult advanced life support Resuscitation. 2015;95:100-147. doi:10.1016/j.resuscitation.2015.07.016 - DOI - PubMed

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