He bet me that by 2020 no Australian ED would still be using a direct laryngoscope per se ( CMAC style VL does not count by our rules!) and Video laryngoscopes would be the standard of care. I told him that would not happen, certainly not by 2020!
Anyway this week an American paper got published online that kinda supports Jo’s world view
One of its main authors Dr Sakles has published earlier this year, demonstrating the importance of first pass intubation success for minimising adverse events. No argument there as lots of previous work showing similar concept is true.
Some points to note about this latest paper seeming to support VL over DL:
– The paper excludes patients under 18yo
-VL devices used are Glidescope or CMAC
-Almost all the intubations in ED done in the paper are by EM residents grades 1-3
-First pass success is statistically greater in the VL group but no mention of overall ETI success is.
-Time to complete intubation is also not described. We know VL in previous studies has been shown to take significantly more time
-Difficult airway characteristics (DAC)are examined in the study and VL seems to improve 1st pass success in those with 1 or more DAC
-No complications of intubation are described such as hypoxia, hypotension, cardiac arrest
Take home messages:
1. This paper supports concept of using VL to intubate by EM residents to improve first pass success, especially for patients with 1 or more DAC
2. It seems confusing to have 2 different VL devices available to choose for EM residents to intubate with. I would not do that. Have 1 and get good at it!
3. I would report time to intubation completion and any airway related complications in future similar studies. The full picture is not described.
Bottom line : Video is killing the direct laryngoscope star..at least amongst EM residents in USA!