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Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department.
Acad Emerg Med 2016; 23(8):870-7AE

Abstract

OBJECTIVES

The objective was to compare video-assisted laryngoscopy (VAL) to direct laryngoscopy (DL) on success rate and complication rate of intubations performed in a pediatric emergency department (ED).

METHODS

This is a retrospective cohort study of attempted intubations of children aged 0-18 years in a pediatric ED between 2004 and 2014 with first attempt by an ED provider. In VAL, the laryngoscopist attempts direct visualization of the glottis with a C-MAC video laryngoscope while the video monitor is used for real-time guidance by a supervisor, back-up visualization for the laryngoscopist should the direct view be inadequate, and confirmation of endotracheal tube passage through the vocal cords. We performed univariate comparisons of intubations using DL to intubations using VAL on rates of first-pass success, complications, and whether the patient was successfully intubated by an ED provider. We then created a logistic regression model to adjust for provider experience level, difficult airway characteristics, and indications for intubation to compare intubations using DL to intubations using VAL for each outcome.

RESULTS

We identified 452 endotracheal intubations of 422 unique patients, of which 445 intubations had a first attempt by an ED provider. Six intubations were excluded due to insufficient information available in the record. Of the included intubations, 240 (55%) were attempted with DL and 199 (45%) with VAL. The overall first-pass success rate was 71% in the DL group and 72% in the VAL group. After adjustment for covariates, the first-pass success rate was similar between laryngoscopy approaches (adjusted odds ratio = 1.23, 95% confidence interval = 0.78 to 1.94).

CONCLUSIONS

We found no difference between DL and VAL with regard to first-pass intubation success rate, complication rate, or rate of successful intubation by ED providers for children undergoing intubation in a pediatric ED.

Authors+Show Affiliations

Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.Division of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA.Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27208690

Citation

Eisenberg, Matthew A., et al. "Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 23, no. 8, 2016, pp. 870-7.
Eisenberg MA, Green-Hopkins I, Werner H, et al. Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Acad Emerg Med. 2016;23(8):870-7.
Eisenberg, M. A., Green-Hopkins, I., Werner, H., & Nagler, J. (2016). Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 23(8), pp. 870-7. doi:10.1111/acem.13015.
Eisenberg MA, et al. Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Acad Emerg Med. 2016;23(8):870-7. PubMed PMID: 27208690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. AU - Eisenberg,Matthew A, AU - Green-Hopkins,Israel, AU - Werner,Heidi, AU - Nagler,Joshua, Y1 - 2016/08/01/ PY - 2015/12/25/received PY - 2016/05/13/revised PY - 2016/05/18/accepted PY - 2016/5/22/entrez PY - 2016/5/22/pubmed PY - 2017/8/23/medline SP - 870 EP - 7 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 23 IS - 8 N2 - OBJECTIVES: The objective was to compare video-assisted laryngoscopy (VAL) to direct laryngoscopy (DL) on success rate and complication rate of intubations performed in a pediatric emergency department (ED). METHODS: This is a retrospective cohort study of attempted intubations of children aged 0-18 years in a pediatric ED between 2004 and 2014 with first attempt by an ED provider. In VAL, the laryngoscopist attempts direct visualization of the glottis with a C-MAC video laryngoscope while the video monitor is used for real-time guidance by a supervisor, back-up visualization for the laryngoscopist should the direct view be inadequate, and confirmation of endotracheal tube passage through the vocal cords. We performed univariate comparisons of intubations using DL to intubations using VAL on rates of first-pass success, complications, and whether the patient was successfully intubated by an ED provider. We then created a logistic regression model to adjust for provider experience level, difficult airway characteristics, and indications for intubation to compare intubations using DL to intubations using VAL for each outcome. RESULTS: We identified 452 endotracheal intubations of 422 unique patients, of which 445 intubations had a first attempt by an ED provider. Six intubations were excluded due to insufficient information available in the record. Of the included intubations, 240 (55%) were attempted with DL and 199 (45%) with VAL. The overall first-pass success rate was 71% in the DL group and 72% in the VAL group. After adjustment for covariates, the first-pass success rate was similar between laryngoscopy approaches (adjusted odds ratio = 1.23, 95% confidence interval = 0.78 to 1.94). CONCLUSIONS: We found no difference between DL and VAL with regard to first-pass intubation success rate, complication rate, or rate of successful intubation by ED providers for children undergoing intubation in a pediatric ED. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/27208690/Comparison_Between_Direct_and_Video_assisted_Laryngoscopy_for_Intubations_in_a_Pediatric_Emergency_Department_ L2 - https://doi.org/10.1111/acem.13015 DB - PRIME DP - Unbound Medicine ER -