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Efficacy of Video Laryngoscopy vs. Direct Laryngoscopy During Urgent Endotracheal Intubation: A Randomized Controlled Trial FREE TO VIEW

Michael Silverberg, MD; Nan Li, MD; Pierre Kory, MD
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Beth Israel Medical Center, New York, NY

Chest. 2013;144(4_MeetingAbstracts):580A. doi:10.1378/chest.1689305
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SESSION TITLE: Use of Technology in Training

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: To assess the efficacy of video laryngoscopy use during urgent endotracheal intubation (UEI) in critically-ill patients.

METHODS: We performed a single-center prospective randomized controlled trial that compared UEI using a direct laryngoscope (DL) versus a video-laryngoscope (VL) by Pulmonary/Critical Care Medicine (PCCM) fellows from September 2012 to March 2013. In the first month of fellowship, all PCCM fellows participated in a multi-component, validated training program on airway management including instruction in DL and VL techniques. Inclusion criteria were all patients undergoing UEI by a PCCM fellow. Exclusion criteria were elective intubations, oxygen saturation below 92% after bag mask ventilation, and presence of recognized difficult airway. Each fellow utilized a sequential even/odd randomization strategy. The primary outcome measure was the rate of first pass success (FPS). Secondary outcomes were the rates of complications including severe desaturation (sat <80%), hypotension (SBP <70), and cardiac arrest.

RESULTS: 114 consecutive UEI performed by PCCM fellows were included. 56 were randomized to the VL group and 58 to the DL group. Apache scores were similar between groups (19.2 +/- 8.8 vs. 19.7 +/- 9.7). 71% of the VL group achieved FPS compared to 40% of the DL group (p< 0.001). 9 % of UEI in the VL group required more than 2 attempts compared to 47% in the DL group (p< 0.001). All unsuccessful DL patients were successfully intubated with VL, 81% on the first attempt. The number of esophageal intubations (0 vs. 4, p<.05) was greater in the DL group. Other complication rates were similar: aspiration events (9% vs. 7%, p=0.69), desaturation (4% vs. 7%, p=0.43), and hypotension (11% vs. 14%, p=0.52). One dental injury occurred in the DL group. One cardiac arrest occurred in the VL group.

CONCLUSIONS: VL improves the FPS rate and decreases the complications of UEI performed by PCCM fellows when compared to DL.

CLINICAL IMPLICATIONS: Fellowship training programs should adopt VL as the primary intubating device for UEI performed by PCCM fellows to maximize the safety and success of this high-risk procedure.

DISCLOSURE: The following authors have nothing to disclose: Michael Silverberg, Nan Li, Pierre Kory

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