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Decreased time to intubation by experienced users with a new lens-clearing video laryngoscope in a simulated setting

Published:February 17, 2021DOI:https://doi.org/10.1016/j.ajem.2021.02.028
      Traditionally, direct laryngoscopy (DL) has been the preferred method to perform endotracheal intubations. Over the last two decades, however, video laryngoscopy (VL) has become increasingly prevalent not only in hospital-based environments but increasingly in pre-hospital and combat settings as well [
      • Brown 3rd, C.A.
      • Bair A.E.
      • Pallin D.J.
      • Walls R.M.
      • NEAR III Investigators
      Techniques, success, and adverse events of emergency department adult intubations.
      ,
      • Zaouter C.
      • Calderon J.
      • Hemmerling T.M.
      Videolaryngoscopy as a new standard of care.
      ]. To date, there exist several studies that compare VL to DL in both pre-hospital and hospital settings with varied results, however not all uniformly show any of the VL systems to be superior to DL [
      • Levitan R.M.
      • Heitz J.W.
      • Sweeney M.
      • Cooper R.M.
      The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices.
      ,
      • Jiang J.
      • Ma D.
      • Li B.
      • Yue Y.
      • Xue F.
      Video laryngoscopy does not improve the intubation outcomes in emergency and critical patients--a systematic review and meta-analysis of randomized controlled trials.
      ,
      • Healy D.W.
      • Maties O.
      • Hovord D.
      • Kheterpal S.
      A systematic review of the role of videolaryngoscopy in successful orotracheal intubation.
      ,
      • Nouruzi-Sedeh P.
      • Schumann M.
      • Groeben H.
      Laryngoscopy via macintosh blade versus GlideScopeSuccess rate and time for endotracheal intubation in untrained medical personnel.
      ,
      • Mosier J.M.
      • Whitmore S.P.
      • Bloom J.W.
      • Snyder L.S.
      • Graham L.A.
      • Carr G.E.
      • et al.
      Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit.
      ,
      • Lascarrou J.B.
      • Boisrame-Helms J.
      • Bailly A.
      • Le Thuaut A.
      • Kamel T.
      • Mercier E.
      • et al.
      Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients.
      ,
      • Driver B.E.
      • Prekker M.E.
      • Moore J.C.
      • Schick A.L.
      • Reardon R.F.
      • Miner J.R.
      Direct versus video laryngoscopy using the C-MAC for tracheal intubation in the emergency department, a randomized controlled trial.
      ]. A known disadvantage of using VL is that the lens may become soiled while in the oropharynx, requiring the user to remove and clean the device [
      • Lockey D.J.
      • Healey B.
      • Crewdson K.
      • Chalk G.
      • Weaver A.E.
      • Davies G.E.
      Advanced airway management is necessary in prehospital trauma patients.
      ,
      • Naito H.
      • Guyette F.X.
      • Martin-Gill C.
      • Callaway C.W.
      Video laryngoscopic techniques associated with intubation success in a helicopter emergency medical service system.
      ,
      • Lockey D.J.
      • Avery P.
      • Harris T.
      • Davies G.E.
      • Lossius H.M.
      A prospective study of physician pre-hospital anaesthesia in trauma patients: the rate of oesophageal intubation, gross airway contamination and the value of the “quick look” airway assessment.
      ,
      • Wong E.
      • Ng Y.-Y.
      The difficult airway in the emergency department.
      ]. This may prolong intubation times and result in increased attempts and desaturation [
      • Martin L.D.
      • Mhyre J.M.
      • Shanks A.M.
      • Tremper K.K.
      • Kheterpal S.
      3,423 emergency tracheal intubations at a university hospital airway outcomes and complications.
      ,
      • Mort T.C.
      Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts.
      ,
      • Schwartz D.E.
      • Matthay M.A.
      • Cohen N.H.
      Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations.
      ,
      • Hasegawa K.
      • Shigemitsu K.
      • Hagiwara Y.
      • Chiba T.
      • Watase H.
      • Brown 3rd, C.A.
      • et al.
      Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study.
      ].

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