scholarly journals Effect of Operator Experience on Cormack-Lehane Grade of View and First Pass Success During Tracheal Intubation in the ICU

2020 ◽  
Author(s):  
W. Brown ◽  
M.W. Semler ◽  
D.R. Janz ◽  
D. Russell ◽  
A.M. Joffe ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Operator Experience ◽  
Lehane Grade ◽  
First Pass

scholarly journals Tracheal Intubation by Specialist Paramedics (Critical Care) in a United Kingdom Ambulance Service: a Service Evaluation.

2021 ◽  
Author(s):  
Silas Houghton Budd ◽  
Eleanor Alexander-Elborough ◽  
Richard Brandon ◽  
Chris Fudge ◽  
Scott Hardy ◽  
...  
Keyword(s):  
Critical Care ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Service Evaluation ◽  
Ambulance Service ◽  
Lehane Grade ◽  
First Pass ◽  
The Subject ◽  
Drug Free ◽  
Hospital Cardiac Arrest

Abstract BackgroundDrug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it.MethodsWe conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie.ResultsThere were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%).ConclusionSpecialist paramedics (critical care) are able to deliver drug-free tracheal intubation with high first-pass success and very high overall success and are therefore both safe and competent at this intervention.

scholarly journals Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Silas Houghton Budd ◽  
Eleanor Alexander-Elborough ◽  
Richard Brandon ◽  
Chris Fudge ◽  
Scott Hardy ◽  
...  
Keyword(s):  
Critical Care ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Service Evaluation ◽  
Ambulance Service ◽  
Lehane Grade ◽  
First Pass ◽  
The Subject ◽  
Drug Free ◽  
Hospital Cardiac Arrest

Abstract Background Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it. Methods We conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie. Results There were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt, Conclusion Specialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.

Association of Cormack Lehane grade and first-pass success with hyper-angulated videolaryngoscopes

2020 ◽  
Vol 30 ◽  
pp. e146-e147
Author(s):  
Taketo Watase ◽  
Olesya Baker ◽  
Andrew Latimer ◽  
Medley Gatewood ◽  
Calvin Brown
Keyword(s):  
Lehane Grade ◽  
First Pass

scholarly journals EXPERIENCE OF VIDEO LARYNGOSCOPY DURING TRACHEAL INTUBATION FOR EMERGENCY INDICATIONS IN THE PRACTICE OF AN ANESTHESIOLOGIST AND RESUSCITATOR

2020 ◽  
Vol 21 (3) ◽  
pp. 33-38
Author(s):  
V. V. Vasilev
Keyword(s):  
Tracheal Intubation ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Successful Intubation ◽  
Failed Intubation ◽  
Advantages And Disadvantages ◽  
Lehane Grade ◽  
Grade Ii ◽  
The Mean ◽  
Technical Solutions

Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.

Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project

2021 ◽  
pp. emermed-2020-209944
Author(s):  
Alistair Steel ◽  
Charlotte Haldane ◽  
Dan Cody
Keyword(s):  
Emergency Medicine ◽  
Tracheal Intubation ◽  
Airway Management ◽  
First Line ◽  
Prehospital Emergency Medicine ◽  
Laryngeal Inlet ◽  
Advanced Airway ◽  
Intubation Success ◽  
First Pass ◽  
Prehospital Emergency

IntroductionAdvanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting.MethodsAn East of England physician–paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016–2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team’s views of VL introduction.Results919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments.ConclusionDespite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.

scholarly journals Tracheal intubation: Improving first pass success with smart material solutions

2017 ◽  
Vol 2 (3) ◽  
pp. 15-18
Author(s):  
Philip Breedon ◽  
Francesco Siena ◽  
James Armstrong
Keyword(s):  
Tracheal Intubation ◽  
Smart Material ◽  
First Pass

scholarly journals Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial

2021 ◽  
Author(s):  
Amanjot Singh ◽  
Rupinder Kaur ◽  
Gurpreet Singh ◽  
Kewal Krishan Gupta
Keyword(s):  
Clinical Trial ◽  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Randomised Clinical Trial ◽  
P Value ◽  
Group I ◽  
Head Extension ◽  
Number Of Patients ◽  
Lehane Grade ◽  
Group Ii

Introduction: Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. Aim: To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. Materials and Methods: The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient’s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student’s t-test and Chi-square test. Results: Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). Conclusion: The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position.

Macintosh laryngoscope, i-view™, and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: A randomized, crossover, manikin study

2020 ◽  
Author(s):  
Toshiyuki Nakanishi ◽  
Yoshiki Sento ◽  
Yuji Kamimura ◽  
Kazuya Sobue
Keyword(s):  
Intensive Care ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Video Laryngoscope ◽  
Interquartile Range ◽  
Intubation Time ◽  
Lehane Grade ◽  
Significant Difference ◽  
Difficulty Scale

Abstract Background: The aerosol box was designed to prevent cough droplets from spreading, but it can impede tracheal intubation. We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the i-view™ video laryngoscope (i-view) with an integrated display, or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.Methods: This prospective, randomized, crossover simulation study was conducted at an operating room of the two hospitals (a university hospital and a tertiary teaching hospital). We recruited 37 medical personnel (36 anesthesiologists and 1 dental anesthesiologist) who were working in the fields of anesthesia and intensive care with > 2 years of dedicated anesthesia experience from five hospitals. We divided the participants into six groups to use the laryngoscope in a determined order. After the training using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least two-hour intervals. The primary outcome was the intubation time. The secondary outcomes were the success rate, Cormack-Lehane grade, and subjective difficulty scale score (numeric rating scale 0–10, 0: no difficulty, 10: highest difficulty). We used the Friedman test and the Wilcoxon signed-rank test with Bonferroni adjustment. Data are shown as median [interquartile range].Results: Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P=0.247). The success rate was 95%–100% without significant difference (P=0.135). The i-view and C-MAC video laryngoscopes exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh laryngoscope; however, there were no differences between the i-view and C-MAC video laryngoscopes.Conclusions: Rapid and highly successful tracheal intubation was possible with Macintosh laryngoscope, i-view, and C-MAC video laryngoscopes on a manikin with an aerosol box. Improved Cormack-Lehane grade and ease of procedure may support the use of video laryngoscopes.Trial registration: UMIN Clinical Trials Registry, identifier UMIN000040269.

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