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Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department.
Intern Emerg Med 2014; 9(1):93-8IE

Abstract

The objective of the study is to compare the efficacy of video laryngoscopy (VL) to direct laryngoscopy (DL) on the first pass intubation success of patients with difficult airway characteristics (DACs) in the emergency department (ED). Over a 6-year period, between July 1 2007 and June 30 2013, all intubations performed in an academic ED were recorded in a continuous quality improvement (CQI) database by the operators. The CQI form included information such as patient demographics, operator level of training, device(s) used, number of attempts and outcome of each attempt. In addition, operators performed a difficult airway assessment and noted the presence or absence of the following difficult airway characteristics (DACs): airway edema, cervical immobility, facial/neck trauma, large tongue, obesity, short neck, small mandible, and blood or vomit in the airway. Patients <18 years of age and those not intubated by an emergency physician (EP) were excluded from the analysis. Multivariate regression models were developed to determine the effect of device type (VL or DL) on first pass intubation success as the number of DACs increased. A total of 2,423 intubations were included in this study. First pass success by the number of DACs was as follows in the VL and DL groups, respectively: no DACs [90.8 % (95 % CI 87.5-93.4) vs. 82.0 % (95 % CI 78.0-85.5)]; one DAC [85.1 % (95 % CI 81.2-88.5 %) vs. 69.4 % (95 % CI 63.9-74.5 %)]; two DACs [(80.5 % (95 % CI 74.7-85.6 %) vs. 65.8 % (95 % CI 57.6-73.3 %)]; three or more DACs [68.9 % (95 % CI 63.8-73.7 %) vs. 54.1 % (95 % CI 46.3-61.8 %)]. After adjusting for potential confounders, VL was associated with higher odds of first pass success for patients with no DACs (aOR 2.0, 95 % CI 1.2-3.3), one DAC (aOR 3.2, 95 % CI 1.9-5.6), two DACs (aOR 2.3, 95 % CI 1.1-4.9), and three or more DACs (aOR 2.9, 95 % CI 1.5-5.5). In patients with DACs, VL was associated with a higher first pass success than DL. VL is recommended as the primary intubating device for patients with predicted difficult airways in the ED.

Authors+Show Affiliations

University of Arizona, Tucson, AZ, USA, sakles@aemrc.arizona.edu.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

24002788

Citation

Sakles, John Constantine, et al. "Comparison of Video Laryngoscopy to Direct Laryngoscopy for Intubation of Patients With Difficult Airway Characteristics in the Emergency Department." Internal and Emergency Medicine, vol. 9, no. 1, 2014, pp. 93-8.
Sakles JC, Patanwala AE, Mosier JM, et al. Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. Intern Emerg Med. 2014;9(1):93-8.
Sakles, J. C., Patanwala, A. E., Mosier, J. M., & Dicken, J. M. (2014). Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. Internal and Emergency Medicine, 9(1), pp. 93-8. doi:10.1007/s11739-013-0995-x.
Sakles JC, et al. Comparison of Video Laryngoscopy to Direct Laryngoscopy for Intubation of Patients With Difficult Airway Characteristics in the Emergency Department. Intern Emerg Med. 2014;9(1):93-8. PubMed PMID: 24002788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. AU - Sakles,John Constantine, AU - Patanwala,Asad E, AU - Mosier,Jarrod M, AU - Dicken,John Michael, Y1 - 2013/09/04/ PY - 2013/07/19/received PY - 2013/08/21/accepted PY - 2013/9/5/entrez PY - 2013/9/5/pubmed PY - 2015/4/9/medline SP - 93 EP - 8 JF - Internal and emergency medicine JO - Intern Emerg Med VL - 9 IS - 1 N2 - The objective of the study is to compare the efficacy of video laryngoscopy (VL) to direct laryngoscopy (DL) on the first pass intubation success of patients with difficult airway characteristics (DACs) in the emergency department (ED). Over a 6-year period, between July 1 2007 and June 30 2013, all intubations performed in an academic ED were recorded in a continuous quality improvement (CQI) database by the operators. The CQI form included information such as patient demographics, operator level of training, device(s) used, number of attempts and outcome of each attempt. In addition, operators performed a difficult airway assessment and noted the presence or absence of the following difficult airway characteristics (DACs): airway edema, cervical immobility, facial/neck trauma, large tongue, obesity, short neck, small mandible, and blood or vomit in the airway. Patients <18 years of age and those not intubated by an emergency physician (EP) were excluded from the analysis. Multivariate regression models were developed to determine the effect of device type (VL or DL) on first pass intubation success as the number of DACs increased. A total of 2,423 intubations were included in this study. First pass success by the number of DACs was as follows in the VL and DL groups, respectively: no DACs [90.8 % (95 % CI 87.5-93.4) vs. 82.0 % (95 % CI 78.0-85.5)]; one DAC [85.1 % (95 % CI 81.2-88.5 %) vs. 69.4 % (95 % CI 63.9-74.5 %)]; two DACs [(80.5 % (95 % CI 74.7-85.6 %) vs. 65.8 % (95 % CI 57.6-73.3 %)]; three or more DACs [68.9 % (95 % CI 63.8-73.7 %) vs. 54.1 % (95 % CI 46.3-61.8 %)]. After adjusting for potential confounders, VL was associated with higher odds of first pass success for patients with no DACs (aOR 2.0, 95 % CI 1.2-3.3), one DAC (aOR 3.2, 95 % CI 1.9-5.6), two DACs (aOR 2.3, 95 % CI 1.1-4.9), and three or more DACs (aOR 2.9, 95 % CI 1.5-5.5). In patients with DACs, VL was associated with a higher first pass success than DL. VL is recommended as the primary intubating device for patients with predicted difficult airways in the ED. SN - 1970-9366 UR - https://www.unboundmedicine.com/medline/citation/24002788/Comparison_of_video_laryngoscopy_to_direct_laryngoscopy_for_intubation_of_patients_with_difficult_airway_characteristics_in_the_emergency_department_ L2 - https://dx.doi.org/10.1007/s11739-013-0995-x DB - PRIME DP - Unbound Medicine ER -