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VL vs DL in a critical care transport service

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Prehosp Emerg Care, 2012
Comparison of Video Laryngoscopy and Direct Laryngoscopy in a Critical Care Transport Service
Guyette, FX; Farrell, K; Carlson, JN; Callaway, CW; Phrampus, P

Abstract Objective. We evaluated video laryngoscopy (VL) (C-MAC, Karl Storz, Tuttlingen, Germany) for use in a critical care transport system. We hypothesized that the total number of airway attempts would decrease when using a video laryngoscope versus use of direct laryngoscopy (DL). Methods. We performed a nonrandomized group-controlled trial where six aircraft were outfitted with VL and the remainder utilized DL responding to a mix of scene runs and interfacility transports. Our primary outcome measure was the number of intubation attempts. We also compared the first-pass success (FPS) rates, laryngoscopic grades, and frequencies of rescue device use (including utilization of surgical airways) between VL and DL. Results. Crews intubated 348 patients with VL and 510 with DL. Successful endotracheal intubation within three attempts occurred 97.6% (confidence interval [CI] 96.5-98.6) of the time. The FPS rate was 85.8% (CI 83.4-88.1). In this cohort of patients, VL did not differ from DL with respect to total number of airway attempts (1.17 [CI 1.11-1.22] vs. 1.16 [CI 1.12-1.20]), FPS rate (85.6% [CI 82-89%] vs. 86.1% [CI 83-89]), or use of rescue airways (2.6% vs. 2.2%). The laryngoscopic view was superior in the VL group relative to the DL group (median Cormack-Lehane grade 1 [interquartile range (IQR) 1, 2] vs. 2 [IQR 1, 2]).

Conclusion. VL using the C-MAC video laryngoscope did not reduce the total number of airway attempts or improve intubation compared with DL in a system of highly trained providers.

Address: From the Department of Emergency Medicine (FXG, KF, JNC, CWC), University of Pittsburgh, Pittsburgh, Pennsylvania; the Medical Department (FXG), STAT MedEvac, West Mifflin, Pennsylvania; and the WISER Center (PP), University of Pittsburgh , Pittsburgh , Pennsylvania .

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