scholarly journals Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers

Critical Care ◽  
2012 ◽  
Vol 16 (1) ◽  
pp. R24 ◽  
Author(s):  
Hans Lossius ◽  
Jo Røislien ◽  
David J Lockey
Keyword(s):  
Patient Safety ◽  
Tracheal Intubation ◽  
Meta Analysis ◽  
Success Rates ◽  
Hospital Emergency ◽  
Intubation Success

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 Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Blood Gas ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Ventilation Efficiency

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, ventilation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the ventilation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

A Meta-Analysis of Prehospital Airway Control Techniques Part I: Orotracheal and Nasotracheal Intubation Success Rates

2010 ◽  
Vol 14 (3) ◽  
pp. 377-401 ◽  
Author(s):  
Michael W. Hubble ◽  
Lawrence Brown ◽  
Denise A. Wilfong ◽  
Attila Hertelendy ◽  
Randall W. Benner ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Nasotracheal Intubation ◽  
Success Rates ◽  
Airway Control ◽  
Control Techniques ◽  
Intubation Success

scholarly journals Recent trends in airway management

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 159 ◽  
Author(s):  
Joelle Karlik ◽  
Michael Aziz
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Intubation ◽  
Success Rates ◽  
Technological Advances ◽  
Life Saving ◽  
Intubation Success ◽  
Life Threatening ◽  
Recent Trends ◽  
Surgical Airway

Tracheal intubation remains a life-saving procedure that is typically not difficult for experienced providers in routine conditions. Unfortunately, difficult intubation remains challenging to predict and intubation conditions may make the event life threatening. Recent technological advances aim to further improve the ease, speed, safety, and success of intubation but have not been fully investigated. Video laryngoscopy, though proven effective in the difficult airway, may result in different intubation success rates in various settings and in different providers’ hands. The rescue surgical airway remains a rarely used but critical skill, and research continues to investigate optimal techniques. This review highlights some of the new thoughts and research on these important topics.

scholarly journals Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Blood Gas ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway Management ◽  
Emergency Airway

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, resuscitation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the resuscitation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

scholarly journals Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized manikin and human studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Human Studies ◽  
Laryngeal Mask ◽  
Insertion Time ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway

Abstract Background Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.Methods Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators were overall intubation success rates, success rates of the initial intubation, insertion time, ventilation efficiency rates, SpO2 rise time and blood gas index. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.Results We included 9 randomized manikin studies and 31 human studies. Meta-analysis of the manikin studies showed that the overall intubation success rates of the laryngeal mask group [RR=1.10, 95% CI (1.02, 1.18), P<0.05] and the success rates of first intubation [RR=1.25, 95% CI (1.01, 1.55), P <0.05] were significantly higher than the endotracheal intubation group. The insertion time of the laryngeal mask group was also significantly shorter [SMD = -1.53, 95% CI (-1.88, -1.17), P <0.05]. In human studies, excluding the success rates of first intubation and insertion time, the laryngeal mask was superior to endotracheal intubation and improved the patients’ blood gas index and shortened the SpO2 rise time. All the results were statistically significant.Conclusions Compared to endotracheal intubation, laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application .

scholarly journals Comparison of Standard Polyvinyl Chloride Tracheal Tubes and Straight Reinforced Tracheal Tubes for Tracheal Intubation through Different Sizes of the Airtraq Laryngoscope in Anesthetized and Paralyzed Patients

2009 ◽  
Vol 111 (6) ◽  
pp. 1265-1270 ◽  
Author(s):  
Vassilios K. Dimitriou ◽  
Ioannis D. Zogogiannis ◽  
Amalia K. Douma ◽  
Nikolaos D. Pentilas ◽  
Despoina G. Liotiri ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Polyvinyl Chloride ◽  
Odds Ratio ◽  
Successful Intubation ◽  
Success Rates ◽  
Tube Size ◽  
Straight Wire ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Tube Type

Background The authors compared the intubation success rate of straight reinforced tracheal tubes emerging from the Airtraq laryngoscope (Prodol Meditec S.A., Vizcaya, Spain) with standard preformed polyvinyl chloride tracheal tubes in anesthetized patients. Methods The authors randomly allocated 347 adult patients to be intubated with standard polyvinyl chloride tracheal tubes, standard straight wire-reinforced tracheal tubes, or silicone straight wire-reinforced tubes, through either the larger or the smaller adult laryngoscope sizes. The possible influence of laryngoscope size, tube size, and tube type on intubation failure was examined. Results Success rates were 100% for polyvinyl chloride tracheal tubes, 78.5% for standard wire-reinforced tracheal tubes, and 75.4% for silicone wire-reinforced tubes (P &lt; 0.01). Compared with the former, patients in the straight standard and silicone wire-reinforced tube groups required more optimization maneuvers (4.1% vs. 42.1%; P &lt; 0.01) and more attempts at successful intubation (0% vs. 7.3%; P &lt; 0.01). The angle created by the tube emerging from the Airtraq guiding channel was inversely correlated to the ratio of the endotracheal tube OD to the width of the channel in the standard and silicone wire-reinforced tube groups (r = -0.95 and r = -0.82, respectively; P &lt; 0.01). Finally, a decrease in 0.1 of the above ratio was associated with a 3.1 (95% confidence interval, 1.9-5.2; P &lt; 0.01) times increase in the odds ratio of intubation failure. Conclusions Standard polyvinyl chloride tracheal tubes were found to be superior compared with standard and silicone straight wire-reinforced tubes for intubation through the Airtraq laryngoscope. In the latter groups, a decrease of the ratio of their OD to the width of the Airtraq guiding channel resulted in increased intubation failure.

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