Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults

2016 ◽  
Vol 125 (4) ◽  
pp. 656-666 ◽  
Author(s):  
Michael F. Aziz ◽  
Ansgar M. Brambrink ◽  
David W. Healy ◽  
Amy Wen Willett ◽  
Amy Shanks ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Perioperative Outcomes ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Success Rates ◽  
Intubation Success Rate ◽  
Lighted Stylet

Abstract Background Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Methods Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. Results A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Conclusions Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

scholarly journals Comparative Effectiveness of the C-MAC Video Laryngoscope versus  Direct Laryngoscopy in the Setting of the Predicted Difficult Airway

2012 ◽  
Vol 116 (3) ◽  
pp. 629-636 ◽  
Author(s):  
Michael F. Aziz ◽  
Dawn Dillman ◽  
Rongwei Fu ◽  
Ansgar M. Brambrink
Keyword(s):  
Tracheal Intubation ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Controlled Trial ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Success Rates ◽  
Intubation Success ◽  
Intubation Success Rate

Background Video laryngoscopy may be useful in the setting of the difficult airway, but it remains unclear if intubation success is improved in routine difficult airway management. This study compared success rates for tracheal intubation with the C-MAC® video laryngoscope (Karl Storz, Tuttlingen, Germany) with conventional direct laryngoscopy in patients with predicted difficult airway. Methods We conducted a two arm, single-blinded randomized controlled trial that involved 300 patients. Inclusion required at least one of four predictors of difficult intubation. The primary outcome was successful tracheal intubation on first attempt. Results The use of video laryngoscopy resulted in more successful intubations on first attempt (138/149; 93%) as compared with direct laryngoscopy (124/147; 84%), P = 0.026. Cormack-Lehane laryngeal view was graded I or II in 139/149 of C-MAC attempts versus 119/147 in direct laryngoscopy attempts (P < 0.01). Laryngoscopy time averaged 46 s (95% CI, 40-51) for the C-MAC group and was shorter in the direct laryngoscopy group, 33 s (95% CI, 29-36), P < 0.001. The use of a gum-elastic bougie and/or external laryngeal manipulation were required less often in the C-MAC intubations (24%, 33/138) compared with direct laryngoscopy (37%, 46/124, P = 0.020). The incidence of complications was not significantly different between the C-MAC (20%, 27/138) versus direct laryngoscopy (13%, 16/124, P = 0.146). Conclusion A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

scholarly journals Does Video Laryngoscopy or Direct Laryngoscopy affect first pass success rates for intubation among Attending and Non-Attending Emergency Physician in the Emergency Department?

2019 ◽  
Author(s):  
Paul Weng Wan ◽  
Zakaria Nur Diana ◽  
Seow Gek Ching ◽  
Wong Evelyn
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
First Pass ◽  
Lemon Score

Abstract Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending Emergency Physicians in South-East Asia. We aim to identify whether the use of Direct Laryngoscopy (DL) compared to Video Laryngoscopy (VL) affects first pass success rates between Attending Emergency Physicians (AEP) and Non-Attending Emergency Physicians (NAEP). Materials and Methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by and academic Emergency Department in Singapore. Primary outcome is first pass success intubation rate. The secondary outcome was first pass success rate for difficult intubations. Difficult intubations were defined as LEMON score of more than 1 or more than 1 attempt at intubation. Results: There were 2909 intubation carried out by emergency physicians in the Emergency Department from 2009 to 2016. AEP conducted 1748 intubations while NAEP conducted 1161 intubations. The first pass success rates for AEP was 84.2% while that for NAEP was 67.4%. 86.2% of intubations by AEP were done with a direct laryngoscope. 89.0% of the intubations by NAEP were done with a direct laryngoscope. 18.9% of intubations by the AEP were difficult compared to 35.2% by the NAEP (p<0.01 95% C.I 13.0%-19.6%). First pass success rate with VL was lower than DL for all intubations (OR 0.66, 95% C.I 0.51-0.84). In the subgroup of difficult intubations, VL did not improve first pass success rate among AEP (OR 0.77, 95% C.I 0.38-1.58) but it did for NAEP (OR 2.46, 95% C.I 0.94-6.45). Conclusion: Our study showed that VL has a poorer first pass success rate for all intubations in general. However, specifically for difficult intubations, VL is associated with improved first pass success rates among NAEP.

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

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.

scholarly journals Does video laryngoscopy or direct laryngoscopy affect first-pass success rates for intubation among attending and non-attending emergency physicians in the emergency department?

2020 ◽  
pp. 102490792091063
Author(s):  
Wan Paul Weng ◽  
Nur Diana Bte Zakaria ◽  
Seow Gek Ching ◽  
Evelyn Wong
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Success Rates ◽  
Mallampati Score ◽  
First Pass

Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending emergency physicians in Southeast Asia. We aim to identify whether the use of direct laryngoscopy compared to video laryngoscopy affects first-pass success rates between attending emergency physicians and non-attending emergency physicians. Materials and methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by an academic Emergency Department in Singapore. Primary outcome was first-pass success intubation rate. Secondary outcome was first-pass success rate for difficult intubations. Difficult intubations were defined as LEMON (Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility) score of more than 1. Results: There were a total of 2909 intubations. Attending emergency physicians conducted 1748 intubations, while non-attending emergency physicians conducted 1161 intubations. The first-pass success rates for AEP were 84.2% and 67.4% for non-attending emergency physicians. Direct laryngoscopy was used in 86.2% of intubation by attending emergency physicians compared to 89.0% in the intubation by non-attending emergency physicians. Also, 7.6% of intubations by the attending emergency physicians were difficult compared to 8.8% by the non-attending emergency physicians (p = 0.25). Logistic regression of the effect of laryngoscopy device on first-pass success in all intubations showed a negative association with video laryngoscopy (odds ratio, 0.70; 95% confidence interval, 0.56–0.88). In the subgroup of difficult intubations, non-attending emergency physicians are 1.54 times (95% confidence interval, 0.53–4.42) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. On the contrary, in the subgroup of difficult intubations, attending emergency physicians are 0.90 times (95% confidence interval, 0.38–2.12) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. Conclusion: Our study showed that video laryngoscopy has a lower first-pass success rate for all intubations in general. Intubations performed by attending emergency physicians with direct laryngoscopy were associated with a higher first-pass success rate.

scholarly journals Direct Laryngoscopy or Video Laryngoscopy: Which Is Better for Performing Endotracheal Intubation?

2021 ◽  
Author(s):  
Zahid Hussain Khan ◽  
Kasra Karvandian ◽  
Haitham Mustafa Muhammed
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
High Morbidity ◽  
Success Rates ◽  
Failed Intubation ◽  
Airway Control ◽  
New Device ◽  
Manual Search

Background: Endotracheal intubation is known as the best and challenging procedure to airway control for patients in shock or with unprotected airways. Failed intubation can have serious consequences and lead to high morbidity and mortality of the patients. Videolaryngoscope is a new device that contains a miniaturized camera at the blade tip to visualize the glottis indirectly. Fewer failed intubations have occurred when a videolaryngoscope was used. Other types of videolaryngoscopes were then developed; all have been shown to improve the view of the vocal cords. It may be inferred that for the professional group, including emergency physicians, paramedics, or emergency nurses, video laryngoscopy may be a good alternative to direct laryngoscopy for intubation under difficult conditions. The incidence of complications was not significantly different between the C-MAC 20% versus direct laryngoscopy 13%. The main goal of this review was to compare the direct laryngoscopy with the (indirect) video laryngoscopy in terms of increased first success rate and good vision of the larynx to find a smooth induction of endotracheal intubation. Methods: Currently available evidence on MEDLINE, PubMed, Google scholar and Cochrane Evidence Based Medicine Reviews, in addition to the citation reviews by manual search of new anesthesia and surgical journals related to laryngoscopies and tracheal intubation. Results: This review of recent studies showed that the laryngoscopic device design would result in smooth approach of endotracheal intubation by means of good visualization of glottis and the best success rates in the hands of both the experienced and novice. Video laryngoscopes may improve safety by avoiding many unnecessary attempts when performing tracheal intubation with DL compared to VL as well as easy learning of both direct and indirect laryngoscopy. Conclusion: The comparative studies of different video laryngoscopes showed that DL compared with VL, reveal that video laryngoscopes reduced failed intubation in anticipated difficult airways, improve a good laryngeal view and found that there were fewer failed intubations using a videolaryngoscope when the intubator had equivalent experience with both devices, but not with DL alone. And therefore, knowledge about ETI and their skills, are crucial in increasing the rate of survival.

scholarly journals Comparison of Simple Stylet versus Lighted Stylet for Intubating the Trachea with a Direct Laryngoscope: A Randomized Clinical Trial

2019 ◽  
Vol 8 (2) ◽  
pp. 140
Author(s):  
Seongjoo Park ◽  
Jeongpyo Hong ◽  
Jin-Woo Park ◽  
Sung-Hee Han ◽  
Jin-Hee Kim
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Sore Throat ◽  
Direct Laryngoscopy ◽  
Intubation Time ◽  
Postoperative Sore Throat ◽  
Suprasternal Notch ◽  
Direct Laryngoscope ◽  
Mucosal Bleeding ◽  
Lighted Stylet

This study investigated the effectiveness of a lighted stylet during tracheal intubation with direct laryngoscopy. The study randomly assigned 284 patients undergoing general anesthesia to either the simple stylet (Group S) or lighted stylet (Group L) groups. In both groups, stylet-assisted intubation was performed with direct laryngoscopy. In group S, a simple stylet was used and removed when the tip of the endotracheal tube was thought to have passed the larynx. In Group L, a lighted stylet was used and removed after confirming transillumination of the suprasternal notch. The success rate at the first attempt, total intubation time, incidence of mucosal bleeding, and severity of postoperative sore throat were compared. Compared to a simple stylet, the lighted stylet significantly increased the success rate of tracheal intubation at the first attempt (128 (90%) vs. 140 (99%), p = 0.003, Groups S and L, respectively). The incidence of mucosal bleeding was significantly higher in Group S (35 (25%) vs. 19 (13%), p = 0.011, Groups S and L, respectively). The total intubation time and degree of postoperative sore throat were not significantly different between the two groups. A lighted stylet increased the success rate of tracheal intubation during stylet-assisted tracheal intubation with direct laryngoscopy.

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Comparison of Airtraq® Laryngoscope, Bonfils Endoscope and Fiberoptic Bronchoscope for Awake Tracheal Intubation: A Randomized, Controlled Trial

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Köhne W ◽  
◽  
Elfers-Wassenhofen A ◽  
Nosch M ◽  
Groeben H ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Local Anesthesia ◽  
Difficult Intubation ◽  
Spontaneous Breathing ◽  
Case Reports ◽  
Controlled Trial ◽  
Fiberoptic Intubation ◽  
Randomized Controlled ◽  
Glottic View

Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.

scholarly journals Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates

2019 ◽  
Vol 129 (2) ◽  
pp. 482-486 ◽  
Author(s):  
Bingdong Tao ◽  
Kun Liu ◽  
Ping Zhao ◽  
Dandan Wang ◽  
Yiming Liu ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy
Sign in / Sign up

Export Citation Format

Share Document