PURPOSE: Video laryngoscopy (VL) has been repeatedly shown to improve glottic views and intubation success rates during elective intubation. We assessed the efficacy of VL during emergency endotracheal intubation (EEI) performed by novice first year pulmonary and critical care fellows (PCCM) in critically-ill patients.
METHODS: We performed a historical-controlled trial of EEI done by first year PCCM fellows in critically-ill patients. The intervention group (VL group, n=51) consisted of all consecutive EEI occuring after institution of a VL as primary device (Glidescope® Verathon Inc, Bothell, WA) over 7 months. The control group (n=43) consisted of all consecutive EEI using direct laryngoscopy (DL) over the same period in a previous year. All EEI during both time periods were performed using a combined team and checklist approach as per protocol. All data on number of attempts during EEI were collected prospectively using a standardized data collection instrument as part of a quality improvement initiative. The primary endpoint was rate of first pass success of EEI.
RESULTS: 88% (45/51) in the VL group vs. 51% (22/43) in the control group were successful on first pass (p<0.01). Mean number of attempts was 1.14 (SD 0.4) in the intervention group compared to 1.53(SD 0.8) in the control group (p<0.01). Intervention by a senior physician occurred in 8% (4/51) vs 5% (2/43) in the VL group compared with 2 out of 43 (5%) in the DL group (p=0.27)
CONCLUSIONS: Primary video laryngoscopy use during EEI performed by first year PCCM fellows increases first pass success rates.
CLINICAL IMPLICATIONS: Video laryngoscopy should be used for EEI performed by first year PCCM fellows to ensure maximal patient safety.
DISCLOSURE: The following authors have nothing to disclose: Edwin Annan, Keith Gueverra, Joseph Mathew, Mohammed Sharif, Jaspreet Ahuja, Abhijith Hegde, Samuel Acquah, Pierre Kory
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