Comparing Emergency Department First-Attempt Intubation Success With Standard-Geometry and Hyperangulated Video Laryngoscopes - 20/08/20
, Matthew E. Prekker, MD a, Robert F. Reardon, MD a, Andrea Fantegrossi, MPH b, Ron M. Walls, MD b, Calvin A. Brown, MD bAbstract |
Study objective |
It is unclear whether laryngoscopy using a standard-geometry blade shape, able to obtain both direct and indirect views, is associated with different first-attempt success or adverse events during emergency intubation compared with using a hyperangulated blade capable of indirect laryngoscopy only. We sought to compare first-attempt intubation success between patients intubated with a standard geometry video laryngoscope versus a hyperangulated video laryngoscope.
Methods |
We analyzed data from the National Emergency Airway Registry from January 2016 to December 2018. Patients aged 14 years or older were included if the first attempt at oral intubation was performed with a standard-geometry or hyperangulated video laryngoscope. We used multiple logistic regression to determine whether blade shape was independently associated with first-attempt intubation success.
Results |
During the study period, 11,927 of 19,071 intubation encounters met inclusion criteria, including 7,255 (61%) with a standard blade and 4,672 (39%) with a hyperangulated blade. Unadjusted analysis revealed higher success with a standard-geometry blade, 91.9% versus 89.2% (absolute difference 2.7% [95% confidence interval 1.6% to 3.8%]; odds ratio for standard-geometry laryngoscope compared with hyperangulated laryngoscope 1.37 [95% confidence interval 1.21 to 1.55]). The logistic regression model, however, demonstrated no association between blade shape and first-attempt success (adjusted odds ratio for standard-geometry laryngoscopy compared with hyperangulated laryngoscopy 1.32 [95% confidence interval 0.81 to 2.17]).
Conclusion |
In this large registry of patients intubated with video laryngoscopy in the emergency department, we observed no association between blade shape (standard-geometry versus hyperangulated laryngoscope) and first-attempt intubation success after adjusting for confounding variables.
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| Please see page 333 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: Michael Gottlieb, MD; Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: BED, MEP, RFR, RMW, and CAB conceived and designed the study. AF contributed to data collection and monitoring. BED performed the data analysis, drafted the initial article, and made final editorial decisions. All authors contributed substantially to article revision. RMW was responsible for creating the registry. CAB was responsible for serving as the registry’s principal investigator. BED takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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Vol 76 - N° 3
P. 332-338 - septembre 2020 Retour au numéro
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