Out-of-Hospital Intubation Success Rates Vary Based on Transport Environment

Objective. To compare novice clinicians’ performance using GlideScope videolaryngoscopy (GVL) to direct laryngoscopy (DL).Methods. This was a prospective, randomized crossover study. Incoming pediatric interns intubated pediatric simulators in four normal and difficult airway scenarios with GVL and DL. Primary outcomes included time to intubation and rate of successful intubation. Interns rated their satisfaction of the devices and chose the preferred device.Results. Twenty-five interns were included. In the normal airway scenario, there were no differences in mean time for intubation with GVL or DL (61.4 versus 67.4 seconds, ) or number of successful intubations (19 versus 18, ). In the difficult airway scenario, interns took longer to intubate with GVL than DL (87.7 versus 61.3 seconds, ), but there were no differences in successful intubations (14 versus 15, ). There was a trend towards higher satisfaction for GVL than DL (7.3 versus 6.4, ), and GVL was chosen as the preferred device by a majority of interns (17/25, 68%).Conclusions. For novice clinicians, GVL does not improve time to intubation or intubation success rates in a pediatric simulator model of normal and difficult airway scenarios. Still, these novice clinicians overall preferred GVL.

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Effect of paramedic experience on orotracheal intubation success rates

Journal of Emergency Medicine ◽

10.1016/s0736-4679(03)00198-7 ◽

2003 ◽

Vol 25 (3) ◽

pp. 251-256 ◽

Cited By ~ 77

Author(s):

Alex G Garza ◽

Matthew C Gratton ◽

Darryl Coontz ◽

Elizabeth Noble ◽

O.John Ma

Keyword(s):

Orotracheal Intubation ◽

Success Rates ◽

Intubation Success

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Proficiencies of Military Medical Officers in Intubating Difficult Airways

10.21203/rs.3.rs-62298/v2 ◽

2020 ◽

Author(s):

Jonathan Zhao Min Lim ◽

Shi Hao Chew ◽

Benjamin Zhao Bin Chin ◽

Raymond Chern Hwee Siew

Keyword(s):

Difficult Airway ◽

Success Rate ◽

Graduate Training ◽

Success Rates ◽

Post Graduate ◽

Airway Trauma ◽

Intubation Success ◽

Post Graduate Training ◽

Difficult Airways ◽

Mean Time

Abstract Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

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OneScope video laryngoscope: Intubation success rates and user satisfaction survey

Trends in Anaesthesia and Critical Care ◽

10.1016/j.tacc.2019.12.459 ◽

2020 ◽

Vol 30 ◽

pp. e187

Author(s):

Karuna Puttur Rajkumar ◽

Gerald Dubowitz ◽

Anthony Roche ◽

Ashish Sinha

Keyword(s):

User Satisfaction ◽

Video Laryngoscope ◽

Satisfaction Survey ◽

Success Rates ◽

Intubation Success

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Comparison of Video Laryngoscopy and Direct Laryngoscopy in the Success of Intubation Performed by Novice Personnel in Patients with Cervical Immobilization: A Manikin Study

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i4.6693 ◽

2021 ◽

Author(s):

Özge Can ◽

Sercan Yalcinli ◽

Yusuf Ali Altunci

Keyword(s):

Success Rate ◽

Direct Laryngoscopy ◽

Video Laryngoscope ◽

Video Laryngoscopy ◽

First Year ◽

Success Rates ◽

Significant Difference ◽

Intubation Success ◽

Cervical Immobilization ◽

Second Year

Introduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization. Methods: In this cross-sectional study, the manikin’s neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.

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Effect of varied training techniques on field endotracheal intubation success rates

Annals of Emergency Medicine ◽

10.1016/s0196-0644(84)80064-5 ◽

1984 ◽

Vol 13 (11) ◽

pp. 1032-1036 ◽

Cited By ~ 91

Author(s):

Ronald D Stewart ◽

Paul M Paris ◽

Gregory H Pelton ◽

Douglas Garretson

Keyword(s):

Endotracheal Intubation ◽

Success Rates ◽

Training Techniques ◽

Intubation Success

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Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313628 ◽

2017 ◽

Vol 103 (5) ◽

pp. F408-F412 ◽

Cited By ~ 6

Author(s):

Joyce E O’Shea ◽

Prakash Loganathan ◽

Marta Thio ◽

C Omar Farouk Kamlin ◽

Peter G Davis

Keyword(s):

Controlled Trial ◽

Objective Assessment ◽

Blade Design ◽

Success Rates ◽

Vocal Cords ◽

Unsuccessful Attempt ◽

Anatomical Structures ◽

Intubation Success ◽

Randomised Controlled ◽

Oesophageal Intubation

ObjectivesNeonatal intubation is a difficult skill to learn and teach. If an attempt is unsuccessful, the intubator and instructor often cannot explain why. This study aims to review videolaryngoscopy recordings of unsuccessful intubations and explain the reasons why attempts were not successful.Study designThis is a descriptive study examining videolaryngoscopy recordings obtained from a randomised controlled trial that evaluated if neonatal intubation success rates of inexperienced trainees were superior if they used a videolaryngoscope compared with a laryngoscope. All recorded unsuccessful intubations were included and reviewed independently by two reviewers blinded to study group. Their assessment was correlated with the intubator’s perception as reported in a postintubation questionnaire. The Cormack-Lehane classification system was used for objective assessment of laryngeal view.ResultsRecordings and questionnaires from 45 unsuccessful intubations were included (15 intervention and 30 control). The most common reasons for an unsuccessful attempt were oesophageal intubation and failure to recognise the anatomy. In 36 (80%) of intubations, an intubatable view was achieved but was then either lost, not recognised or there was an apparent inability to correctly direct the endotracheal tube. Suctioning was commonly performed but rarely improved the view.ConclusionsLack of intubation success was most commonly due to failure to recognise midline anatomical structures. Trainees need to be taught to recognise the uvula and epiglottis and use these landmarks to guide intubation. Excessive secretions are rarely a factor in elective and premedicated intubations, and routine suctioning should be discouraged. Better blade design may make it easier to direct the tube through the vocal cords.

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