Document Detail


Comparison of traditional versus video laryngoscopy in out-of-hospital tracheal intubation.
MedLine Citation:
PMID:  20199237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure.
METHODS: Data were collected on 300 consecutive patients, 6 years of age or older, weighing at least 20 kg, who were intubated using TL. They were compared with data on 315 patients who were intubated using VL. All intubations were confirmed by visualization where possible, auscultation, misting, and capnography. In addition, all were continuously monitored by capnography.
RESULTS: The average time to intubate in the VL group was 21 seconds (range 8-43 seconds) versus 42 seconds (range 28-90 seconds) in the TL group. The average number of attempts was 1.2 (range 1-3) in the VL group versus 2.3 (range 1-4) in the TL group. Successful intubation was 97% in the VL group versus 95% in the TL group. There were no unrecognized misplaced tubes in either group. For failed intubations, an alternative airway was successful in 99% of the VL group and 99% of the TL group. Maximum nonventilated time during any one intubation attempt was 37 seconds in the VL group and 55 seconds in the TL group.
CONCLUSIONS: The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.
Authors:
Marvin A Wayne; Mannix McDonnell
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  14     ISSN:  1545-0066     ISO Abbreviation:  Prehosp Emerg Care     Publication Date:    2010 Apr-Jun
Date Detail:
Created Date:  2010-03-04     Completed Date:  2010-06-02     Revised Date:  2012-04-04    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  278-82     Citation Subset:  IM    
Affiliation:
Whatcom Medic One, Bellingham, Washington 98225, USA. mwayne@cob.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Emergency Medical Services*
Female
Humans
Intubation, Intratracheal / instrumentation,  methods*
Laryngoscopes*
Male
Microscopy, Video*
Middle Aged
Northwestern United States
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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