Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial

Am J Emerg Med. 2015 Nov;33(11):1547-51. doi: 10.1016/j.ajem.2015.06.003. Epub 2015 Jun 6.


Introduction: The main cause of cardiac arrest in pediatric patients is respiratory failure.

Objective: To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios.

Methods: This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC.

Results: A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P=.73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P=.67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC (P<.05) for all analyzed variables.

Conclusions: This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Allied Health Personnel*
  • Cardiopulmonary Resuscitation / instrumentation*
  • Cardiopulmonary Resuscitation / methods
  • Child
  • Clinical Competence
  • Cross-Over Studies
  • Female
  • Humans
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Laryngoscopes*
  • Male
  • Manikins
  • Prospective Studies
  • Time Factors