Rapid Sequence Intubation With Video Laryngoscopy Common for Difficult Airways in ED

Predicted difficult airways in one emergency department are managed most often using rapid sequence intubation (RSI) and video laryngoscopy (VL), a recent study has found | Anesthesiology News

Although difficult airways occur frequently in emergency medicine, few studies have investigated the incidence, management and outcomes of these patients, according to the investigators.

“We’ve been collecting airway data at our institution for many years, and this past year we decided to focus on the difficult airway,” said John C. Sakles, MD, professor of emergency medicine at the University of Arizona College of Medicine, in Tucson. Dr. Sakles presented the study at the 2016 annual meeting of the Society for Airway Management.

The study examined 348 nonarrest intubations between July 1, 2015, and March 31, 2016, at Banner University Medical Center, in Tucson. Operators performed a difficult airway assessment and classified the airway into one of three categories: routine, challenging or difficult.

Read the full research overview here


Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study

Schröder, H et al. BMJ Open 2016;6:e010250

Objectives: This study aimed to compare visualisation of the vocal cords and performance of intubation by anaesthetists using four different laryngoscopes while wearing full chemical protective equipment.

Setting: Medical simulation center of a university hospital, department of anaesthesiology.

Participants: 42 anaesthetists (15 females and 27 males) completed the trial. The participants were grouped according to their professional education as anaesthesiology residents with experience of <2 years or <5 years, or as anaesthesiology specialists with experience of >5 years.

Interventions: In a manikin scenario, participants performed endotracheal intubations with four different direct and indirect laryngoscopes (Macintosh (MAC), Airtraq (ATQ), Glidescope (GLS) and AP Advance (APA)), while wearing chemical protective gear, including a body suit, rubber gloves, a fire helmet and breathing apparatus.

Primary and secondary outcome measures: With respect to the manikin, setting time to complete ‘endotracheal intubation’ was defined as primary end point. Glottis visualisation (according to the Cormack-Lehane score (CLS) and impairments caused by the protective equipment, were defined as secondary outcome measures.

Results: The times to tracheal intubation were calculated using the MAC (31.4 s; 95% CI 26.6 to 36.8), ATQ (37.1 s; 95% CI 28.3 to 45.9), GLS (35.4 s; 95% CI 28.7 to 42.1) and APA (23.6 s; 95% CI 19.1 to 28.1), respectively. Intubation with the APA was significantly faster than with all the other devices examined among the total study population (p<0.05). A significant improvement in visualisation of the vocal cords was reported for the APA compared with the GLS.

Conclusions: Despite the restrictions caused by the equipment, the anaesthetists intubated the manikin successfully within adequate time. The APA outperformed the other devices in the time to intubation, and it has been evaluated as an easily manageable device for anaesthetists with varying degrees of experience (low to high), providing good visualisation in scenarios that require the use of chemical protective equipment.

Read the full article here