Airway intubation in a helicopter cabin: video vs. direct laryngoscopy in manikins

Airway management may be required during medical evacuation in a helicopter when patients deteriorate en route. Laryngoscopist positioning at the head of the patient may not be possible, making it difficult to perform direct laryngoscopy (DIR). An alternative method is video laryngoscopy (VID) that displays magnified images of the glottic opening on a video monitor and allows intubation despite nonstandard positioning. There were 21 experienced aeromedical emergency medical personnel who intubated a recumbent manikin with the operator seated at the head of a secured helicopter stretcher in a power-off helicopter. Each subject performed intubations using DIR and VID in standard- and difficult-airway manikins (STD and DIF, respectively). Data were collected for subjective glottic visualization grades, intubation times, and intubation success rates. Visualization grades were 2.43 +/- 0.81 for STD-DIR and 1.10 +/- 0.30 for STD-VID, compared to 1.76 +/- 0.54 for DIF-DIR and 3.72 +/- 0.57 for DIF-VID. Success rates were 95% for both STD-DIR and STD-VID, 5% for DIF-DIR and 95% DIF-VID. Mean intubation time for DIF-VID was 0.90 min +/- 0.80 min, not different from STD-DIR. The success rate for difficult airway intubation by aeromedical personnel in a power-off evacuation helicopter was significantly improved by enhancing glottic visualization using VID vs. DIR in a manikin.