Soiled Airway - Video or Direct Laryngoscopy

Short Attention Span Summary

He slimed me
To no one's surprise, a soiled airway, defined in this study as blood or vomitus in the airway, decreased first-pass success for ETT passage no matter the method used.  In the soiled airway, GlideScope videolaryngoscopy (VL) still outperformed direct laryngoscopy (DL) 81% vs. 66% first-pass success.  I thought the optics would be obscured using VL, making DL better in this situation, but my hunch was wrong.  In the clean airway, VL again was superior to DL, 91% vs. 76% first-pass success.

Spoon Feed
Both DL and VL (with a GlideScope) had reduced first-pass success in patients with vomitus or blood in the airway.  But VL was superior to DL in both soiled and clean airways.

There is a new Cochrane Review comparing VL and DL and commentary on EMCrit.


Abstract

The Impact of a Soiled Airway on Intubation Success in the Emergency Department when using the GlideScope or the Direct Laryngoscope.

Acad Emerg Med. 2017 Jan 20. doi: 10.1111/acem.13160. [Epub ahead of print]

Sakles JC1, Corn GJ2, Hollinger P2, Arcaris B3, Patanwala AE4, Mosier JM5.

Author information:

1Department of Emergency Medicine, The University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245057, Tucson, AZ, 85724.

2Department of Emergency Medicine, The University of Arizona College of Medicine.

3The University of Arizona College of Medicine.

4Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy.

5Department of Emergency Medicine, Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, The University of Arizona College of Medicine.

Abstract

BACKGROUND:

To determine the impact of a soiled airway on first pass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department.

METHODS:

Data were prospectively collected on all patients intubated in an academic emergency department from July 1, 2007 to June 30, 2016. Patients ≥18 years of age, who underwent rapid sequence intubation with the GlideScope or the direct laryngoscope were included in the analysis. Data were stratified by device used (GlideScope or direct laryngoscope). The primary outcome was first pass success. Patients were categorized as those without blood or vomitus (CLEAN) and those with blood or vomitus (SOILED) in their airway. Multivariate regression models were developed to control for confounders.

RESULTS:

When using the GlideScope the first pass success was lower in the SOILED group (249/306; 81.4%) than the in CLEAN group (586/644; 91.0%) (difference 9.6%; 95% CI: 4.7 to 14.5). Similarly, when using the direct laryngoscope, the first pass success was lower in the SOILED group (186/284; 65.5%) than in the CLEAN group (569/751; 75.8%) (difference 10.3%; 95% CI: 4.0 to 16.6). The SOILED airway was associated with a decreased first pass success in both the GlideScope cohort (aOR 0.4; 95% CI: 0.3 to 0.6) and the direct laryngoscope cohort (aOR 0.6; 95% CI: 0.5 to 0.8).

CONCLUSION:

Soiling of the airway was associated with a reduced first pass success during emergency intubation and this reduction occurred to a similar degree whether using either the GlideScope or the direct laryngoscope. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 28109012 [PubMed - as supplied by publisher]