Improved Glottic Exposure With the Video Macintosh Laryngoscope in Adult Emergency Department Tracheal Intubations - 20/08/11
, Aaron E. Bair, MD c, Daniel J. Pallin, MD, MPH a, b, d, Erik G. Laurin, MD c, Ron M. Walls, MD a, bNational Emergency Airway Registry (NEAR) Investigators
Address for correspondence: Calvin A. Brown III, MD, 75 Francis St, NH-312D, Boston, MA 02115; 617-732-8908, fax 617-713-3060Résumé |
Study objective |
Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can complicate laryngoscopy. We measure the difference in glottic visualization with video versus direct laryngoscopy.
Methods |
We prospectively studied a convenience sample of tracheal intubations at 2 academic EDs. We performed laryngoscopy with the Karl Storz Video Macintosh Laryngoscope, which can be used for conventional direct laryngoscopy, as well as video laryngoscopy. We rated glottic visualization with the Cormack-Lehane (C-L) Scale, defining “good” visualization as C-L I or II and “poor” visualization as C-L III or IV. We compared glottic exposure between direct and video laryngoscopy, determining the proportion of poor direct visualizations improved to good visualization with video laryngoscopy. We also determined the proportion of good direct visualizations worsened to poor visualization by video laryngoscopy.
Results |
We report data on 198 patients, including 146 (74%) medical, 51 (26%) trauma, and 1 (0.51%) unknown indications. All were tracheally intubated by emergency physicians. Postgraduate year 3 or 4 residents performed 102 (52.3%) of the laryngoscopies, postgraduate year 2 residents performed 60 (30.8%), interns performed 20 (10.3%), attending physicians performed 9 (4.6%), and operator experience and specialty were not reported in 4. Overall, good visualization (C-L grade I or II) was attained in 158 direct (80%) versus 185 video laryngoscopies (93%; McNemar's P<.0001). Of the 40 patients with poor glottic exposure on direct laryngoscopy, video laryngoscopy improved the view in 31 (78%; 95% confidence interval 62% to 89%). Of the 158 patients with good glottic view on direct laryngoscopy, video laryngoscopy worsened the view in 4 (3%; 95% confidence interval 0.7% to 6%).
Conclusion |
Video laryngoscopy affords more grade I and II views than direct laryngoscopy and improves glottic exposure in most patients with poor direct glottic visualization. In a small proportion of cases, glottic exposure is worse with video than direct laryngoscopy.
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| Supervising editor: Henry E. Wang, MD, MS |
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| Author contributions: CAB served as principal investigator and developed the study concept. CAB and AEB maintained data integrity and site compliance. CAB, DJP, and RMW wrote the article. All authors edited the article. AEB served as primary site investigator at our second center and contributed to study design and article development. DJP performed all database retrievals and performed all statistical analyses. EGL acted as coinvestigator at our second center and contributed to study implementation. RMW created the overall database design and application, as well as the Web-based data entry form, and advised on statistical analyses and reporting of results. CAB takes responsibility for the paper as a whole. |
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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 that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by a research grant from Karl Storz Endoscopy of America (KSEA) for execution of the trial. At each site, KSEA provided 2 video Macintosh laryngoscope blades (sizes 3 and 4), a DCI II video cartridge with cables, and a telepak video display unit. |
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| Publication date: Available online March 3, 2010. |
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| Reprints not available from the authors. |
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| Please see page 84 for the Editor's Capsule Summary of this article. |
Vol 56 - N° 2
P. 83-88 - août 2010 Retour au numéro
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