Tracheal intubation in the emergency department: A comparison of GlideScope® video laryngoscopy to direct laryngoscopy in 822 intubations

John C. Sakles, Jarrod M. Mosier, Stephen Chiu, Samuel M Keim

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: Video laryngoscopy has, in recent years, become more available to emergency physicians. However, little research has been conducted to compare their success to conventional direct laryngoscopy. Objectives: To compare the success rates of GlideScope® (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) with direct laryngoscopy (DL) for emergency department (ED) intubations. Methods: This was a 24-month retrospective observational study of all patients intubated in a single academic ED with a level I trauma center. Structured data forms were completed after each intubation and entered into a continuous quality improvement database. All patients intubated in the ED with either the GlideScope® standard, Cobalt, Ranger, or traditional Macintosh or Miller laryngoscopes were included. All patients intubated before arrival were excluded. Primary analysis evaluated overall and first-attempt success rates, operator experience level, performance characteristics of GVL, complications, and reasons for failure. Results: There were 943 patients intubated during the study period; 120 were excluded due to alternative management strategies. DL was used in 583 (62%) patients, and GVL in 360 (38%). GVL had higher first-attempt success (75%, p = 0.03); DL had a higher success rate when more than one attempt was required (57%, p = 0.003). The devices had statistically equivalent overall success rates. GVL had fewer esophageal intubations (n = 1) than DL (n = 18); p = 0.005. Conclusion: The two techniques performed equivalently overall, however, GVL had a higher overall success rate, and lower number of esophageal complications. In the setting of ED intubations, GVL offers an excellent option to maximize first-attempt success for airway management.

Original languageEnglish (US)
Pages (from-to)400-405
Number of pages6
JournalJournal of Emergency Medicine
Volume42
Issue number4
DOIs
StatePublished - Apr 2012

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Laryngoscopy
Intubation
Hospital Emergency Service
Laryngoscopes
Airway Management
Trauma Centers
Quality Improvement
Cobalt
Observational Studies
Emergencies
Retrospective Studies
Databases
Physicians
Equipment and Supplies
Research

Keywords

  • direct laryngoscopy
  • GlideScope®
  • intubation
  • video laryngoscopy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Tracheal intubation in the emergency department : A comparison of GlideScope® video laryngoscopy to direct laryngoscopy in 822 intubations. / Sakles, John C.; Mosier, Jarrod M.; Chiu, Stephen; Keim, Samuel M.

In: Journal of Emergency Medicine, Vol. 42, No. 4, 04.2012, p. 400-405.

Research output: Contribution to journalArticle

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abstract = "Background: Video laryngoscopy has, in recent years, become more available to emergency physicians. However, little research has been conducted to compare their success to conventional direct laryngoscopy. Objectives: To compare the success rates of GlideScope{\circledR} (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) with direct laryngoscopy (DL) for emergency department (ED) intubations. Methods: This was a 24-month retrospective observational study of all patients intubated in a single academic ED with a level I trauma center. Structured data forms were completed after each intubation and entered into a continuous quality improvement database. All patients intubated in the ED with either the GlideScope{\circledR} standard, Cobalt, Ranger, or traditional Macintosh or Miller laryngoscopes were included. All patients intubated before arrival were excluded. Primary analysis evaluated overall and first-attempt success rates, operator experience level, performance characteristics of GVL, complications, and reasons for failure. Results: There were 943 patients intubated during the study period; 120 were excluded due to alternative management strategies. DL was used in 583 (62{\%}) patients, and GVL in 360 (38{\%}). GVL had higher first-attempt success (75{\%}, p = 0.03); DL had a higher success rate when more than one attempt was required (57{\%}, p = 0.003). The devices had statistically equivalent overall success rates. GVL had fewer esophageal intubations (n = 1) than DL (n = 18); p = 0.005. Conclusion: The two techniques performed equivalently overall, however, GVL had a higher overall success rate, and lower number of esophageal complications. In the setting of ED intubations, GVL offers an excellent option to maximize first-attempt success for airway management.",
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