Skip to content

VL vs DL in a critical care transport service


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 .

No comments yet

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


Implementing Effective Safety Solutions

Emergency Medicine Literature of Note

In memory of Dr John Hinds


Medical education in the tropics

Rural General Practice

Thoughts and experiences on the journey to enlightenment



EM in Focus

time to get focused on your patients.


The ACEM Fellowship Exam Resource

Dr. Smith's ECG Blog

In memory of Dr John Hinds


"Live as if you will die tomorrow; Learn as if you will live forever"

Songs or Stories

Sharing the Science and Art of Paediatric Anaesthesia


In memory of Dr John Hinds

Liz Crowe

Wellbeing Counsellor and Educator


In memory of Dr John Hinds

EM Basic

Your Boot Camp Guide to Emergency Medicine

Medical Admission Note

In memory of Dr John Hinds


Ramblings from a gasdoc with interests in #anaesthesia, #intensivecare, #echo, #PHEM and #FOAM

pulmcrit – EMCrit

In memory of Dr John Hinds

Miss Chardy

Laughter in the Outback

The Collective

A Hive Mind for Prehospital and Retrieval Med

Bits & Bumps

Obstetrics and Gynaecology Podcast


A Free Open Access Medical Education Emergency Medicine Core Content Mash Up

Adventure Medic

Just another site


Or "How I'm Learning to Stop Worrying and Love Emergency Medicine"


A great site

Genevieve's anthology

Writings to amuse, teach, inspire and entertain.

JR Paramedic

In memory of Dr John Hinds

Monash Anaesthesia

In memory of Dr John Hinds


A topnotch site


Bringing the boring to emergency medicine


Navigating resuscitation

Doctor's bag

by Dr Edwin Kruys

EM nerd

In memory of Dr John Hinds

The Chart Review

In memory of Dr John Hinds

ETM Course

Emergency Trauma Management Course

The Doctor's Dilemma

Modern Medical Musings from Dr Marlene Pearce

Sim and Choppers

A blog combining medical education, simulation and helicopter retrieval medicine


Reflections of a Rural GP

Auckland HEMS

Unofficial site for prehospital care providers of the Auckland HEMS service

Rural Doctors Net

useful resources for rural clinicians

expensive care

end of life, ethics and communication in critical care

Nomadic GP

Adventures of a Rural Locum


Free Open Access Medical Education for Paramedics

Not just a GP

Why GP is the greatest job in the world

the short coat

In memory of Dr John Hinds


Bringing the Boring to EM

%d bloggers like this: