A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department.
ABSTRACT The first-attempt success rate of intubation was compared using GlideScope video laryngoscopy and direct laryngoscopy in an emergency department (ED).
A prospective observational study was conducted of adult patients undergoing intubation in the ED of a Level 1 trauma center with an emergency medicine residency program. Patients were consecutively enrolled between August 2006 and February 2008. Data collected included indication for intubation, patient characteristics, device used, initial oxygen saturation, and resident postgraduate year. The primary outcome measure was success with first attempt. Secondary outcome measures included time to successful intubation, intubation failure, and lowest oxygen saturation levels. An attempt was defined as the introduction of the laryngoscope into the mouth. Failure was defined as an esophageal intubation, changing to a different device or physician, or inability to place the endotracheal tube after three attempts.
A total of 280 patients were enrolled, of whom video laryngoscopy was used for the initial intubation attempt in 63 (22%) and direct laryngoscopy was used in 217 (78%). Reasons for intubation included altered mental status (64%), respiratory distress (47%), facial trauma (9%), and immobilization for imaging (9%). Overall, 233 (83%) intubations were successful on the first attempt, 26 (9%) failures occurred, and one patient received a cricothyrotomy. The first-attempt success rate was 51 of 63 (81%, 95% confidence interval [CI] = 70% to 89%) for video laryngoscopy versus 182 of 217 (84%, 95% CI = 79% to 88%) for direct laryngoscopy (p = 0.59). Median time to successful intubation was 42 seconds (range, 13 to 350 seconds) for video laryngoscopy versus 30 seconds (range, 11 to 600 seconds) for direct laryngoscopy (p < 0.01).
Rates of successful intubation on first attempt were not significantly different between video and direct laryngoscopy. However, intubation using video laryngoscopy required significantly more time to complete.
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ABSTRACT: The development of less expensive, smaller, and more reliable video cameras has revolutionized the design of laryngoscopes and the process of endotracheal intubation. The term video laryngoscopy defines a broad range of devices, distinct from fiberoptic bronchoscopes, in which a video camera is used in place of line-of-sight visualization to accomplish endotracheal intubation. Over a dozen laryngoscopes are marketed currently. Each model of video laryngoscope has its own unique strengths, weaknesses, and best applications. For the purposes of this review, video laryngoscopes are grouped into 3 different designs: stylets, guide channels, and video modifications of the traditional (usually Macintosh) laryngoscope blades.Respiratory care 08/2010; 55(8):1036-45. · 2.01 Impact Factor
Article: Evaluation of standard endotracheal intubation, assisted laryngoscopy (airtraq), and laryngeal mask airway in the management of the helmeted athlete airway: a manikin study.[show abstract] [hide abstract]
ABSTRACT: Physicians at sporting events must rarely manage the airway of a helmeted athlete. This poses challenges for providers who do not regularly engage in airway management. In a manikin model, our purpose was to determine (1) if standard endotracheal intubation (ETI) of a simulated helmeted athlete is adversely affected by bright-light conditions and (2) if the use of laryngeal mask airway (LMA) or Airtraq improves airway management success. This is a randomized, prospective, crossover study. The study was conducted at a 500-bed community-based hospital with residency training programs in family medicine and emergency medicine, as well as a fellowship in sports medicine. We randomized 42 residents to manage the airway of a simulated helmeted athlete in c-spine immobilization using ETI, Airtraq, and LMA. Each method was attempted under bright light and in standard light. Our main outcomes were success or failure of airway and time to airway. Secondary outcome was perceived difficulty in airway management as a factor of environmental factors. Airway success rates were 93% for ETI, 99% for LMA, and 75% for Airtraq. Standard ETI was significantly faster than intubation using the Airtraq (P = 0.0001) and had greater success (P = 0.004). Time to airway was faster with LMA than with standard ETI (P < 0.00001). There was no impact of bright light on ETI time (P = 0.61). These results suggest that both ETI and LMA may be acceptable choices for management of the airway in the helmeted athlete. Time to airway was significantly decreased with the use of LMA, regardless of the experience level of the intubator. Lighting conditions had no effect on success.Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 05/2011; 21(4):301-6. · 1.50 Impact Factor
Article: Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial.[show abstract] [hide abstract]
ABSTRACT: The aim of the present study was to evaluate whether different video laryngoscopes (VLs) facilitate endotracheal intubation (ETI) faster or more secure than conventional laryngoscopy in a manikin with immobilized cervical spine. After local ethics board approval, a standard airway manikin with cervical spine immobilization by means of a standard stiff collar was placed on a trauma stretcher. We compared times until glottic view, ETI, cuff block and first ventilation were achieved, and verified the endotracheal tube position, when using Macintosh laryngoscope, Glidescope Ranger, Storz C-MAC, Ambu Pentax AWS, Airtraq, and McGrath Series5 VLs in randomized order. Wilcoxon signed-rank test and McNemar's test were used for statistical analysis; p<0.05 was considered as significant. Twenty-three anaesthetists (mean age 32.1±4.9 years, mean experience in anaesthesia of 6.9±4.8 years) routinely involved in the management of multitrauma patients participated. The primary study end point, time to first effective ventilation, was achieved fastest when using Macintosh laryngoscope (21.0±7.6s) and was significantly slower with all other devices (Airtraq 33.2±23.9 s, p=0.002; Pentax AirwayScope 32.4±14.9 s, p=0.001; Storz C-MAC 34.1±23.9 s, p<0.001; McGrath Series5 101.7±108.3 s, p<0.001; Glidescope Ranger 46.3±59.1 s, p=0.001). Overall success rates were highest when using Macintosh, Airtraq and Storz C-MAC devices (100%), and were lower in Ambu Pentax AWS and Glidescope Ranger (87%, p=0.5) and in McGrath Series5 device (72.2%, p=0.063). When used by experienced anaesthesiologists, video laryngoscopes did not facilitate endotracheal intubation in this model with an immobilized cervical spine in a faster or more secure way than conventional laryngoscopy. However, data was gathered in a standardized model and further studies in real trauma patients are desirable to verify our findings.Resuscitation 12/2011; 83(6):740-5. · 3.60 Impact Factor