Abstract
Objective
Direct laryngoscopy can be performed using curved or straight blades, and providers
usually choose the blade they are most comfortable with. However, curved blades are
anecdotally thought of as easier to use than straight blades. We seek to compare intubation
success rates of paramedics using curved versus straight blades.
Methods
Design: retrospective chart review. Setting: hospital-based suburban ALS service with
20,000 annual calls. Subjects: prehospital patients with any direct laryngoscopy intubation
attempt over almost 9 years. First attempt and overall success rates were calculated for attempts with curved
and straight blades. Differences between the groups were calculated.
Results
2299 patients were intubated by direct laryngoscopy. 1865 had attempts with a curved
blade, 367 had attempts with a straight blade, and 67 had attempts with both. Baseline
characteristics were similar between groups. First attempt success was 86% with a
curved blade and 73% with a straight blade: a difference of 13% (95% CI: 9–17). Overall
success was 96% with a curved blade and 81% with a straight blade: a difference of
15% (95% CI: 12–18). There was an average of 1.11 intubation attempts per patient
with a curved blade and 1.13 attempts per patient with a straight blade (2% difference,
95% CI: −3–7).
Conclusions
Our study found a significant difference in intubation success rates between laryngoscope
blade types. Curved blades had higher first attempt and overall success rates when
compared to straight blades. Paramedics should consider selecting a curved blade as
their tool of choice to potentially improve intubation success.
Keywords
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References
- Evidence for benefit vs novelty in new intubation equipment.Anaesthesia. 2011; 66: 57-64
- Laryngoscope design and the difficult adult tracheal intubation.Can J Anaesth. 1989; 36: 94-98
- Comparison of glottis visualization and ease of intubation with different laryngoscope blades.Indian J Anaesth. 2013; 57: 170-174
- Defining the learning curve for endotracheal intubation using direct laryngoscopy: a systematic review.Resuscitation. 2016; 99: 63-71
- Straight blades improve visualization of the larynx while curved blades increase ease of intubation: a comparison of the Macintosh, Miller, McCoy, Belscope and Lee-Fiberview blades.Can J Anesth. 2003; 50: 501-506
- Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study.Scand J Trauma Resusc Emerg Med. 2013; 21: 58
- Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2327 patients.Scand J Trauma Resusc Emerg Med. 2015; 23: 57
- How many attempts are required to accomplish out-of-hospital endotracheal intubation?.Acad Emerg Med. 2006; 13: 372-377
- Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers.Crit Care. 2012; 16: R24
- Effect of paramedic experience on orotracheal intubation success rates.J Emerg Med. 2003; 25: 251-256
- An analysis of advanced prehospital airway management.J Emerg Med. 2002; 23: 183-189
- Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts.Anesth Analg. 2004; 99: 607-613
Article Info
Publication History
Published online: February 03, 2018
Accepted:
January 30,
2018
Received in revised form:
January 30,
2018
Received:
December 10,
2017
Footnotes
☆Presentations: This research was presented as a poster at the National Association of EMS Physicians 2017 Annual Meeting, January 24–26, 2017 in New Orleans, LA, USA.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
