Abstract
Background
Stylet use during endotracheal intubation (ETI) is variable across medical specialty
and geographic location; however, few objective data exist regarding the impact of
stylet use on ETI performance.
Objective
We evaluated the impact of stylet use on the time required to perform ETI in cases
of simulated difficult airways in novice and experienced providers.
Methods
We performed a prospective, randomized observational study of experienced (attending
anesthesiologists and emergency physicians) vs inexperienced airway providers (emergency
medical technician, paramedic and medical students) comparing the use of stylet vs
no stylet in random order using a simulated difficult airway. The primary outcome
was attempt time for each of 6 attempts defined as entry of the laryngoscope in the
mouth until successfully passing the endotracheal tube past the vocal cords. We analyzed
the data using descriptive statistics including means with SDs and t tests. We used generalized estimating equations to evaluate potential changes in
the attempt time over multiple attempts.
Results
There were 23 providers per group. The mean (SD) inexperienced attempt time in seconds
was 25.88 (28.46) and 10.50 (5.47) for experienced providers (P < .0001). Stylet use did not alter attempt time for either group. When adjusting
for stylet use, the attempt time did not change over repeated intubations (P = .541). When adjusting for experience status, inexperienced intubators had shorter
attempt times with each successive trial, whereas experienced intubators attempt times
remained constant (P < .001).
Conclusion
Stylet use does not improve attempt time in a simulated difficult airway model for
either inexperienced or experienced intubators.
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Article Info
Publication History
Published online: November 19, 2012
Accepted:
September 14,
2012
Received in revised form:
September 11,
2012
Received:
August 8,
2012
Footnotes
☆Financial disclosure: Dr Phrampus works as a consultant for the Karl Storz Corp (El Segundo, CA).
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
