Impact of the use of an automated chest-compression device on airway management during out-of-hospital cardiopulmonary resuscitation: the PLAINT study

Introduction: Automated chest-compression devices (ACCDs) have recently been proposed in the management of out-of-hospital cardiac arrest (cardiopulmonary resuscitation, CPR). During CPR, it is still unknown whether the ACCD or intubation is to be first implemented. Knowing the impact of an ACCD on intubation conditions could strongly contribute to determine the best sequence. Therefore, we undertook an experimental study on intubation conditions on a mannequin with or without the use of an ACCD.

Methods: Emergency physicians and nurses experienced in the field of cardiac-arrest management (including orotracheal intubation) were randomly assigned to three scenarios to intubate a mannequin: patient lying on the floor without an ACCD (group 1), patient lying on the floor with the ACCD switched off (group 2) or switched on (group 3). The primary end point was intubation time. Estimated intubation difficulty evaluated on a visual analogue scale (VAS), ranging from 0 (easy) to 100 (impossible), number of attempts, Cormack grade and dental traumatisms associated with the intubation procedure were secondary end points.

Results: A total of 44 operators performed the intubation. Times to intubation were 14 (11-22), 15 (10-21) and 18 (15-27)s for groups 1, 2 and 3, respectively. The VAS difficulties were 12 (5-25), 15 (10-25) and 15 (5-21), respectively. Intubation conditions did not differ between the 'without an ACCD group' and the 'switched-off ACCD group'. In the 'switched-on ACCD group', time to intubation was significantly increased in comparison with groups 1 and 2 with a median difference of 4 (1-10) and 3 (0-7)s, respectively. The VAS difficulty was also significantly increased in the 'switched-on ACCD group'. Other secondary end-point criteria did not differ between the three groups.

Conclusion: Due to the major role of compression during CPR, we suggest that the ACCD should not be systematically switched off for routine intubation.