Effect of cooled tracheal tubes on time to intubate and first pass intubation success in novice intubators: A randomized crossover manikin study

Polyvinyl chloride (PVC) tracheal tubes (TTs) may change in stiffness with changing temperatures. Cooling an TT may increase its rigidity and may assist in maintaining its slope at the tip. In this study, we aim to investigate the effects of a cooled TT on intubation time and first pass success. In a randomized cross-over design, senior medical students without prior intubation experience performed intubation with a direct laryngoscope on a manikin. During the first group's intubations, cooled TTs were used first and then room temperature TTs, while the second group performed it vice versa. The primary outcome was the time to intubation. As secondary outcomes, first pass success, esophageal intubation, and dental click were measured. The study included 21 participants. Cooled TT intubations (61.9%) had significantly higher first-pass success rates than room temperature TT intubations (33.3%) (p = 0.031). When room temperature TT was used for intubations, the mean time to intubation was 14.33 (95% CI 5.59e23.08) seconds longer than when cooled TT was used (p = 0.003). In terms of esophageal intubation and dental click rates, there was no statistically significant difference between the groups (p = 0.754, p = 0.99, respectively). In this manikin study, we observed that novice intubators performed intubation with improved time to intubate and higher first pass success using cooled TT. (c) 2023 Elsevier Ltd. All rights reserved.