Article

A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department.

Department of Emergency Medicine, University of California San Francisco, Fresno, CA, USA.
Academic Emergency Medicine (impact factor: 1.86). 08/2009; 16(9):866-71. DOI:10.1111/j.1553-2712.2009.00492.x pp.866-71
Source: PubMed

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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Keywords

95% confidence interval [CI]
 
adult patients undergoing intubation
 
direct laryngoscopy
 
emergency department
 
emergency medicine residency program
 
endotracheal tube
 
facial trauma
 
first attempt
 
first-attempt success rate
 
GlideScope video laryngoscopy
 
initial intubation attempt
 
initial oxygen saturation
 
Level 1 trauma center
 
lowest oxygen saturation levels
 
patient characteristics
 
primary outcome measure
 
prospective observational study
 
respiratory distress
 
Secondary outcome measures
 
video laryngoscopy