Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians

In patients with known or suspected difficult airways, advanced airway procedures such as fiberoptic laryngoscopy (under general anesthesia—with and without supraglottic airways—and sometimes in awake patients) as well as video laryngoscopy are invaluable. All may be particularly advantageous for use with patients who have limited or reduced cervical spine movement. Other advantages and disadvantages are addressed in this chapter. Techniques for nasotracheal intubation are also described. Flexible fiberoptic laryngoscopy is a means of indirectly visualizing airway structures by threading a fiberoptic scope with a camera at the end of the scope into the airway. The goal of fiberoptic laryngoscopy is endotracheal intubation using a Seldinger technique, whereby an endotracheal tube is guided into the trachea over the fiberoptic bronchoscope. Fiberoptic endotracheal intubation may be performed through the mouth or nose, or through a supraglottic airway (SGA). The use of the fiberoptic scope through an SGA is an especially useful technique in infants who suffer from airway obstruction at rest (e.g., infants with Pierre Robin syndrome). Video laryngoscopy employs a laryngoscope with a camera at the end of the blade to enable the user to indirectly visualize airway structures.

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C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation

Medicina ◽

10.3390/medicina55060225 ◽

2019 ◽

Vol 55 (6) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

Byeong Chul Min ◽

Jong Eun Park ◽

Gun Tak Lee ◽

Tae Rim Kim ◽

Hee Yoon ◽

...

Keyword(s):

Emergency Department ◽

Logistic Regression ◽

Cardiopulmonary Resuscitation ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Multiple Logistic Regression Analysis ◽

Video Laryngoscope ◽

Multiple Logistic Regression ◽

Total N ◽

Significant Difference

Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17–2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.

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First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01326-z ◽

2020 ◽

Vol 46 (5) ◽

pp. 1039-1045 ◽

Cited By ~ 2

Author(s):

Wim Breeman ◽

Mark G. Van Vledder ◽

Michael H. J. Verhofstad ◽

Albert Visser ◽

Esther M. M. Van Lieshout

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Prospective Observational Study ◽

Primary Outcome ◽

Spontaneous Circulation ◽

Video Laryngoscope ◽

Video Laryngoscopy ◽

Direct Laryngoscope ◽

Positive Effect

Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

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