Abstract
Background
Direct laryngoscopy (DL) has long been the gold standard for tracheal intubation in emergency and trauma patients. Video laryngoscopy (VL) is increasingly used in many settings and the purpose of this study was to compare its effectiveness to direct laryngoscopy in trauma patients. Our hypothesis was that the success rate of VL would be higher than that of DL.
Methods
Data were collected prospectively on all trauma patients, from January 2008 to June 2011, who were intubated emergently in an academic level I trauma center. After intubation, the physician that performed the intubation completed a structured data collection form that included demographics, complications, and the presence of difficult airway predictors. Our primary outcome measure was overall successful tracheal intubation, which was defined as successful intubation with the first device used.
Results
During the study period, 709 trauma patients were intubated by either VL or DL. VL was performed in 55 % of cases. The overall success rate of VL was 88 % compared to 83 % with DL (P = 0.05). Cervical (C-Spine) immobilization was predictive of higher initial success with VL (87 %) than with DL (80 %) (P < 0.05). In multivariate regression analysis DL was associated with higher risk of intubation failure compared to VL (OR 1.82, CI: 1.15–2.86).
Conclusions
In trauma patients intubated emergently, VL had a significantly higher success rate than DL. These data suggest that, in select circumstances, VL is superior to DL for the intubation of trauma patients with difficult airways.
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References
Burkle CM, Zepeda FA, Bacon DR et al (2004) A historical perspective on use of the laryngoscope as a tool in anesthesiology. Anesthesiology 100:1003–1006
Agro F, Barzoi G, Montecchia F (2003) Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth 90:705–706
Sakles JC, Mosier JM, Chiu S et al (2012) Tracheal intubation in the emergency department: a comparison of GlideScope(R) video laryngoscopy to direct laryngoscopy in 822 intubations. J Emerg Med 42:400–405
Sakles JC, Patanwala AE, Mosier JM et al (2014) Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. Intern Emerg Med 9:93–98
Niforopoulou P, Pantazopoulos I, Demestiha T et al (2010) Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand 54:1050–1061
Kim HJ, Chung SP, Park IC et al (2008) Comparison of the GlideScope video laryngoscope and Macintosh laryngoscope in simulated tracheal intubation scenarios. Emerg Med J 25:279–282
Savoldelli GL, Schiffer E, Abegg C et al (2008) Comparison of the Glidescope, the McGrath, the Airtraq and the Macintosh laryngoscopes in simulated difficult airways*. Anaesthesia 63:1358–1364
Bair AE, Olmsted K, Brown CA 3rd et al (2010) Assessment of the storz video Macintosh laryngoscope for use in difficult airways: a human simulator study. Acad Emerg Med 17:1134–1137
Koh JC, Lee JS, Lee YW et al (2010) Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation. Korean J Anesthesiol 59:314–318
Zamora JE, Nolan RL, Sharan S et al (2011) Evaluation of the Bullard, GlideScope, Viewmax, and Macintosh laryngoscopes using a cadaver model to simulate the difficult airway. J Clin Anesth 23:27–34
Nasim S, Maharaj CH, Butt I et al (2009) Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins. BMC Emerg Med 9:2
Mosier JM, Stolz U, Chiu S et al (2012) Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J Emerg Med 42:629–634
Tan BH, Liu EH, Lim RT et al (2009) Ease of intubation with the GlideScope or Airway Scope by novice operators in simulated easy and difficult airways–a manikin study. Anaesthesia 64:187–190
Benjamin FJ, Boon D, French RA (2006) An evaluation of the GlideScope, a new video laryngoscope for difficult airways: a manikin study. Eur J Anaesthesiol 23:517–521
McElwain J, Malik MA, Harte BH et al (2010) Comparison of the C-MAC videolaryngoscope with the Macintosh, Glidescope, and Airtraq laryngoscopes in easy and difficult laryngoscopy scenarios in manikins. Anaesthesia 65:483–489
Kortbeek JB, Al Turki SA, Ali J et al (2008) Advanced trauma life support, 8th edition, the evidence for change. J Trauma 64:1638–1650
Langeron O, Birenbaum A, Amour J (2009) Airway management in trauma. Minerva Anestesiol 75:307–311
Stephens CT, Kahntroff S, Dutton RP (2009) The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center. Anesth Analg 109:866–872
Yeatts DJ, Dutton RP, Hu PF et al (2013) Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. The journal of trauma and acute care surgery 75:212–219
Thiboutot F, Nicole PC, Trepanier CA et al (2009) Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anaesth 56:412–418
Santoni BG, Hindman BJ, Puttlitz CM et al (2009) Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology 110:24–31
Aoi Y, Inagawa G, Hashimoto K et al (2011) Airway scope laryngoscopy under manual inline stabilization and cervical collar immobilization: a crossover in vivo cinefluoroscopic study. J Trauma 71:32–36
Mort TC (2004) Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 99:607–613
Hirabayashi Y, Fujita A, Seo N et al (2008) A comparison of cervical spine movement during laryngoscopy using the Airtraq or Macintosh laryngoscopes. Anaesthesia 63:635–640
Maruyama K, Yamada T, Kawakami R et al (2008) Randomized cross-over comparison of cervical-spine motion with the AirWay Scope or Macintosh laryngoscope with in-line stabilization: a video-fluoroscopic study. Br J Anaesth 101:563–567
Maruyama K, Yamada T, Kawakami R et al (2008) Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope. Br J Anaesth 100:120–124
Turkstra TP, Pelz DM, Jones PM (2009) Cervical spine motion: a fluoroscopic comparison of the AirTraq Laryngoscope versus the Macintosh laryngoscope. Anesthesiology 111:97–101
Dupanovic M, Fox H, Kovac A (2010) Management of the airway in multitrauma. Curr Opin Anaesthesiol 23:276–282
Malik MA, Maharaj CH, Harte BH et al (2008) Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth 101:723–730
Takahashi K, Morimura N, Sakamoto T et al (2010) Comparison of the Airway Scope and Macintosh laryngoscope with in-line cervical stabilization by the semisolid neck collar: manikin study. J Trauma 68:363–366
Malik MA, Subramaniam R, Churasia S et al (2009) Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes. Br J Anaesth 102:654–661
Malik MA, O’Donoghue C, Carney J et al (2009) Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study. Br J Anaesth 102:128–134
Aoi Y, Inagawa G, Nakamura K et al (2010) Airway scope versus macintosh laryngoscope in patients with simulated limitation of neck movements. J Trauma 69:838–842
Liu EH, Goy RW, Tan BH et al (2009) Tracheal intubation with videolaryngoscopes in patients with cervical spine immobilization: a randomized trial of the Airway Scope and the GlideScope. Br J Anaesth 103:446–451
Wetsch WA, Spelten O, Hellmich M et al (2012) Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial. Resuscitation 83:740–745
Hardcastle TC, Goff T (2007) Trauma unit emergency doctor airway management. S Afr Med J 97:864–867
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Michailidou, M., O’Keeffe, T., Mosier, J.M. et al. A Comparison of Video Laryngoscopy to Direct Laryngoscopy for the Emergency Intubation of Trauma Patients. World J Surg 39, 782–788 (2015). https://doi.org/10.1007/s00268-014-2845-z
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DOI: https://doi.org/10.1007/s00268-014-2845-z