Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema - 13/12/19

Doi : 10.1016/j.ajem.2019.02.012

Seth Parkey, DO ^a, Thomas Erickson, DO ^a, Emily M. Hayden, MD, MHPE ^b, Calvin A. Brown III, MD ^c, Jestin N. Carlson, MD, MS ^a,^{^⁎}
^a Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA, United States of America
^b Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
^c Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America

^⁎Corresponding author at: Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, 232 West 25th St, Erie, PA 16544, United States of America.Department of Emergency MedicineAllegheny Health NetworkSaint Vincent Hospital232 West 25th StEriePA16544United States of America

Abstract

Background

Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown.

Methods

We performed a randomized, crossover manikin study using a convenience sample of emergency physicians and medical students from a local community teaching hospital. Using a simulated angioedema model, we sought to compare the time required to successfully perform nasotracheal intubation between traditional blind nasotracheal intubation and FNI. Participants performed nasal intubation with both FNI using the Ambu aScope Slim (Ambu, Ballarup, Denmark) and blind nasal intubation with a Parker Endotrol tube (Parker, CO) in random order. Number of attempts and time to successful intubation (TTI) were compared between treatment devices. Providers were stratified by experience level, defining junior providers as post-graduate level 2 and below (including medical students) and all others as senior providers.

Results

We enrolled a convenience sample of 20 providers ranging from medical students to attendings. Overall, the TTI did not differ between blind and FNI intubation techniques (difference in seconds; 95% confidence interval) (21.4; −2.1 to 44.9; p = 0.07). This was consistent across provider types: senior providers (26.6; −17.7 to 71; p = 0.24) and junior providers (18.6; −8.3 to 46.5; p = 0.18). Number of attempts was similar between techniques (p = 0.55).