Comparison Between Direct and Video‐assisted Laryngoscopy for Intubations in a Pediatric Emergency Department

Eisenberg, Matthew; Green-Hopkins, Israel; Werner, Heidi; Nagler, Joshua

doi:10.1111/acem.13015

Cited by 42 publications

(40 citation statements)

References 37 publications

(57 reference statements)

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“…[ 9 ] Kerrey et al's study, which reported a 64% (48/75) first-attempt intubation success rate using VL, was used to estimate the possible effect of this intervention, which was an increment of 25% from the first-attempt intubation success rate (64%–39%). [ 12 ] Considering a statistical power of 80%, significance of 95%, 2-tailed t test, and 94 cases in the first group, the 46 cases in the study group should demonstrate a 25% increase in the first-attempt intubation success rate.…”

Section: Methodsmentioning

confidence: 99%

“…The laryngoscopist initially attempted a direct visualization of the glottis using a C-MAC video laryngoscope (Karl Storz, Germany), whereas the video screen was used by a supervisor for real-time guidance. [ 12 ] Similarly, Kerrey et al used the C-MAC video laryngoscope as the first device for pediatric intubation with providers performing intubation with DL and a “copilot” attending physician watching the video screen. This strategy reached a first-attempt intubation success rate of 64% on a filmed intubation review.…”

Section: Introductionmentioning

confidence: 99%

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Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Couto¹,

Reis²,

Farhat³

et al. 2020

Medicine

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The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation–associated events and desaturation among these patients. Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years. The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups ( P < .01), respectively. There was a lower proportion of tracheal intubation–associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; P = .06). The median number of attempts was 1 (range, 1–5) for the VL group and 2 (range, 1–8) for the DL group ( P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9–10.4, P < 0.01). Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation–associated events.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Couto¹,

Reis²,

Farhat³

et al. 2020

Medicine

View full text Add to dashboard Cite

show abstract

“…Varghese and Kundu, evaluating intubation among twenty children aged 1-24 months, indicated that the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions. Verghese and Kundu's study showed that [22]. In turn, Hippard et al showed higher success rates and shorter intubation times with the Miller blade compared to either videolaryngoscope which may reflect one's greater experience in direct laryngoscopy [23].…”

Section: Discussionmentioning

confidence: 97%

Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study

Wojewódzka-Żelezniakowicz

Madziala²,

Madziała

2017

Disaster Emerg Med J

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INTRODUCTION: Airway management in pediatric trauma patients is challenging. Direct laryngoscopy is the gold standard for endotracheal intubation in emergency and trauma patients. The aim of the present study was to evaluate the performance of Miller (MIL) and Macintosh (MAC) laryngoscopes when employed in emergency pediatric intubation scenarios. METHODS: This was a prospective, randomized, crossover, single-center study on novice physicians recruited on a voluntary basis. Each participant performer endotracheal intubation using Miller or Macintosh laryngoscopes during two airway scenarios: Scenario A-normal airway; Scenario B-difficult airway, defined as scenario in which the patient was placed on backboard with neck immobilization performer using rigid cervical collar. The order of use of one or other of the devices was randomized with a ratio of 1:1. The primary endpoint was the first attempt success rate. RESULTS: The effectiveness of the first intubation attempt in Scenario B for MAC was 36.8%, for MIL-44.7%; while in Scenario A for MAC this was 36.8%, for MIL-44.7%. During Scenario A, the median duration time of intubation using MIL was 24.5 s [IQR; 21-32.5] and 23 s [IQR; 20.5-31] for MAC. During Scenario B, median intubation time with the MAC laryngoscope was 40.5 [IQR; 36.5-47] s, and with MIL 37.5 [IQR; 33-44.5] seconds. CONCLUSIONS: We concluded that in trauma pediatric patients the Miller laryngoscope is associated with higher first attempt success rates than the Macintosh laryngoscope. These data suggest that for patients with cervical spine immobilization, the Miller laryngoscope should be the preferred method of intubation in emergency medicine conditions.

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“…As shown by Long et al in a paediatric emergency department, the overall first-pass success rate was 78%, although first-pass success without desaturation or hypotension was only 49% [7]. In turn, studies by Eisenberg et al indicate the effectiveness of the first intubation attempt at the level of 71% [8], while the study by Pallin et al showed 83% [9]; however, in the above studies the intubation was performed by emergency physicians or anaesthesiologists. In out-of-hospital conditions or in a situation where intubation is performed by less experienced personnel, the effectiveness of intubation can range from 63.4% to 78.6% [10][11][12].…”

Section: Introductionmentioning

confidence: 91%

The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

Bielski¹,

Szarpak²,

Pyda³

2018

polp

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Introduction: The main causes of cardiac arrest in paediatric patients are airway obstruction and progressive hypoxia. Rapid endotracheal intubation and the implementation of mechanical ventilation during cardiopulmonary resuscitation (CPR) can affect the minimisation of chest compressions and adequate oxygenation of the blood, and thus increase the chances of spontaneous circulation return. Aim of the study: The aim of the study was to compare intubation using a standard Macintosh blade (MAC) laryngoscope and blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask (AMBU) as a guide for the tracheal tube under simulated CPR conditions of a paediatric patient with and without chest compressions. Material and methods: Fifty-six students from the final year of medicine studies participated in this trial. The study was designed as a randomised, cross-over, simulation study. Participants of the study performed endotracheal intubation during simulated CPR of a paediatric patient, with and without chest compressions during an intubation procedure. Participants had a maximum of three attempts to intubate each of the techniques in individual research scenarios. Results: The median time of intubation in CPR without chest compressions using MAC and AMBU was 32 s (interquartile range-IQR; 27-41.5) and 30 s (IQR; 22-43), respectively. The efficacy of the first intubation trial was 28.6% for MAC and 48.2% for AMBU, and the total intubation efficiency for both techniques was 100%. In the case of intubation during uninterrupted chest compressions, blind intubation using AMBU as the guide for the endotracheal tube was associated with better parameters than in the case of intubation using MAC, with respect to both intubation time (32 s [IQR; 22-45] and 47 s [IQR; 33-57], respectively; p = 0.017), effectiveness of the first intubation trial (33.9% and 5.4%, p = 0.002), as well as the total effectiveness of intubation (73.2% and 46.2%, p < 0.001). Conclusions: In our study, blind endotracheal intubation using AMBU was associated with more effective endotracheal intubation than standard intubation using direct laryngoscopy, both when the chest compressions were interrupted for the time of intubation and in the case of intubation during uninterrupted chest compressions.

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Comparison Between Direct and Video‐assisted Laryngoscopy for Intubations in a Pediatric Emergency Department

Cited by 42 publications

References 37 publications

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study

The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

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