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Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation.
Simul Healthc. 2009 Fall; 4(3):160-5.SH

Abstract

INTRODUCTION

A number of devices, including video laryngoscopy, are used to aid in managing difficult airways. The goal of this study was to compare timing and success of video laryngoscopy to standard laryngoscopic intubation using a simulation mannequin in normal and difficult airway scenarios.

METHODS

Residents and attending physicians of a PGY 2-4 emergency medicine residency program participated. A single, high-fidelity simulation mannequin was used. Each participant received an in-service on the video laryngoscope (GlideScope). Three airway settings were used: standard, decreased neck mobility, and tongue edema. Participants intubated with a Macintosh blade and video laryngoscope in each scenario, and graded the best view achieved using the Cormack-Lehane classification. Outcome measures included time to view the vocal cords, time to intubation, grading of view, and intubation success or failure. Institutional Review Board approval was obtained.

RESULTS

Fifty-two participants were enrolled. Participants successfully intubated the mannequin faster using the Macintosh blade in both the normal and neck immobility settings (9.4 seconds faster, 95% CI 3.2-15.7, P = 0.004, 16.1 seconds faster, 95% CI 3.6-28.7, P = 0.01). In the tongue edema setting, however, video laryngoscopy provided a better grade view of the cords, a higher success rate of viewing the cords at time of intubation (50% vs. 12%), and a higher rate of successful intubations (83% vs. 23%). The GlideScope also significantly reduced the time needed to view the cords (89 seconds reduction, 95% CI 54.4-123.7, P < 0.0001) and intubate (131.3 seconds reduction, 95% CI 99.1-163.6, P< 0.0001) for the tongue edema setting.

CONCLUSIONS

In the most difficult airway case, tongue edema, the video laryngoscope provided an enhanced view of the cords using less time, increased intubation success, and decreased the time to intubation.

Authors+Show Affiliations

Department of Emergency Medicine Boston Medical Center, Boston, Massachusetts 02118, USA. annarang@bmc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19680083

Citation

Narang, Aneesh T., et al. "Comparison of Intubation Success of Video Laryngoscopy Versus Direct Laryngoscopy in the Difficult Airway Using High-fidelity Simulation." Simulation in Healthcare : Journal of the Society for Simulation in Healthcare, vol. 4, no. 3, 2009, pp. 160-5.
Narang AT, Oldeg PF, Medzon R, et al. Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simul Healthc. 2009;4(3):160-5.
Narang, A. T., Oldeg, P. F., Medzon, R., Mahmood, A. R., Spector, J. A., & Robinett, D. A. (2009). Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simulation in Healthcare : Journal of the Society for Simulation in Healthcare, 4(3), 160-5. https://doi.org/10.1097/SIH.0b013e318197d2e5
Narang AT, et al. Comparison of Intubation Success of Video Laryngoscopy Versus Direct Laryngoscopy in the Difficult Airway Using High-fidelity Simulation. Simul Healthc. 2009;4(3):160-5. PubMed PMID: 19680083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. AU - Narang,Aneesh T, AU - Oldeg,Paula F, AU - Medzon,Ron, AU - Mahmood,Ahmed R, AU - Spector,Jordan A, AU - Robinett,Derek A, PY - 2009/8/15/entrez PY - 2009/8/15/pubmed PY - 2009/10/2/medline SP - 160 EP - 5 JF - Simulation in healthcare : journal of the Society for Simulation in Healthcare JO - Simul Healthc VL - 4 IS - 3 N2 - INTRODUCTION: A number of devices, including video laryngoscopy, are used to aid in managing difficult airways. The goal of this study was to compare timing and success of video laryngoscopy to standard laryngoscopic intubation using a simulation mannequin in normal and difficult airway scenarios. METHODS: Residents and attending physicians of a PGY 2-4 emergency medicine residency program participated. A single, high-fidelity simulation mannequin was used. Each participant received an in-service on the video laryngoscope (GlideScope). Three airway settings were used: standard, decreased neck mobility, and tongue edema. Participants intubated with a Macintosh blade and video laryngoscope in each scenario, and graded the best view achieved using the Cormack-Lehane classification. Outcome measures included time to view the vocal cords, time to intubation, grading of view, and intubation success or failure. Institutional Review Board approval was obtained. RESULTS: Fifty-two participants were enrolled. Participants successfully intubated the mannequin faster using the Macintosh blade in both the normal and neck immobility settings (9.4 seconds faster, 95% CI 3.2-15.7, P = 0.004, 16.1 seconds faster, 95% CI 3.6-28.7, P = 0.01). In the tongue edema setting, however, video laryngoscopy provided a better grade view of the cords, a higher success rate of viewing the cords at time of intubation (50% vs. 12%), and a higher rate of successful intubations (83% vs. 23%). The GlideScope also significantly reduced the time needed to view the cords (89 seconds reduction, 95% CI 54.4-123.7, P < 0.0001) and intubate (131.3 seconds reduction, 95% CI 99.1-163.6, P< 0.0001) for the tongue edema setting. CONCLUSIONS: In the most difficult airway case, tongue edema, the video laryngoscope provided an enhanced view of the cords using less time, increased intubation success, and decreased the time to intubation. SN - 1559-2332 UR - https://www.unboundmedicine.com/medline/citation/19680083/Comparison_of_intubation_success_of_video_laryngoscopy_versus_direct_laryngoscopy_in_the_difficult_airway_using_high_fidelity_simulation_ L2 - https://doi.org/10.1097/SIH.0b013e318197d2e5 DB - PRIME DP - Unbound Medicine ER -