Comparison of Video Laryngoscopy and Direct Laryngoscopy in a Critical Care Transport Service. (6th March 2013)

• Record Type: Journal Article
• Authors: Guyette, Francis X.; Farrell, Kathryn; Carlson, Jestin N.; Callaway, Clifton W.; Phrampus, Paul
• Is Part Of: Prehospital emergency care. Volume 17:Number 2(2013:Apr./Jun.)
• Page Start: 149
• Page End: 154
• Publication Date: 2013-03-06
• Subjects: 362.18
• DOI: 10.3109/10903127.2012.729128
• Languages: English
• ISSNs: 1090-3127

Abstract

<abstract> <title>Abstract</title> <p> <bold>Objective.</bold> We evaluated video laryngoscopy (VL) (C-MAC, Karl Storz, Tuttlingen, Germany) for use in a critical care transport system. We hypothesized that the total number of airway attempts would decrease when using a video laryngoscope versus use of direct laryngoscopy (DL). <bold>Methods.</bold> We performed a nonrandomized group-controlled trial where six aircraft were outfitted with VL and the remainder utilized DL responding to a mix of scene runs and interfacility transports. Our primary outcome measure was the number of intubation attempts. We also compared the first-pass success (FPS) rates, laryngoscopic grades, and frequencies of rescue device use (including utilization of surgical airways) between VL and DL. <bold>Results.</bold> Crews intubated 348 patients with VL and 510 with DL. Successful endotracheal intubation within three attempts occurred 97.6% (confidence interval [CI] 96.5–98.6) of the time. The FPS rate was 85.8% (CI 83.4–88.1). In this cohort of patients, VL did not differ from DL with respect to total number of airway attempts (1.17 [CI 1.11–1.22] vs. 1.16 [CI 1.12–1.20]), FPS rate (85.6% [CI 82–89%] vs. 86.1% [CI 83-89]), or use of rescue airways (2.6% vs. 2.2%). The laryngoscopic view was superior in the VL group relative to the DL group (median Cormack-Lehane grade 1 [interquartile range (IQR) 1, 2] vs. 2 [IQR 1, 2]). <bold>Conclusion.</bold> VL using the C-MAC video laryngoscope did not reduce the total number of airway attempts or improve intubation compared with DL in a system of highly trained providers.</p> </abstract>