• Temple EM

The use of a video laryngoscope by emergency medicine residents is associated with a reduction in es

The Article:

Sakles JC, Javedani PP, Chase E1, et al. “The use of a video laryngoscope by emergency medicine residents is associated with a reduction in esophageal intubations in the emergency department.” Acad Emerg Med. 2015 Jun;22(6):700-7

The Idea:

Endotracheal intubation in the Emergency Department (ED) setting has numerous risks and complications. Misplacement of the endotracheal tube into the esophagus has been previously reported to be as high as 19% and is associated with higher adverse events, such as hypoxemia, aspiration, arrhythmia, and cardiac arrest. In recent years, video laryngoscopy (VL) has become commonplace as either a primary tool for intubation or as “back-up” in the event of failed or difficult direct laryngoscopy (DL). This study compares the incidence of esophageal intubation and associated complications for DL versus VL.

The Study:

This was a prospective, observational study performed at an academic ED over a 6-year period. Only intubations performed by Emergency Medicine (EM) residents were analyzed. VL types included the C-MAC and the Glidescope; noteworthy was that if the C-MAC was used as DL, it was considered a “VL” attempt. The authors controlled for difficult airway characteristics.

The Result:

During the 6 year period, 2,961 patients were intubated in the ED with 3,425 total attempts documented. For 134 attempts, there was no DL or VL attempted, and 150 were not performed by EM residents. DL was used in 1,530 (44.7%), and a VL was used in 1,895 attempts (55.3%). The type of VL was Glidescope in 1,064 attempts (56.2%) and CMAC in 831 attempts (43.9%). In total, 96 intubation attempts (2.8%) resulted in an esophageal intubation; 78 occurred with DL (5%) and 18 with VL (1%). Two of the esophageal intubations in the VL group occurred with the use of C-MAC as DL (2 of 189 attempts).

The odds of NOT performing an esophageal intubation with VL when compared to DL was 6.9, with an adjusted odds ratio of 7.8. Those patients who were esophageally intubated experienced over twice as many adverse events when compared to DL (49.5% vs. 19.5%): The incidence of aspiration and dysrhythmia were both 6 times higher in the DL group, hypotension 3 times higher, and hypoxemia was 2 times higher.

The Takeaway:

VL is associated with a lower incidence of esophageal intubation and adverse events.

#airwaymanagement

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