Laryngoscopic Intubation

Mulcaster, Julian T.; Mills, Joanna; Hung, Orlando; MacQuarrie, Kirk; Law, J. Adam; Pytka, Saul; Imrie, David; Field, Chris

doi:10.1097/00000542-200301000-00007

Cited by 316 publications

(62 citation statements)

References 7 publications

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“…Several investigators have reported that the mean success rate for the first 10 intubations via direct laryngoscopy by medical personnel untrained in tracheal intubation is about 35–65% and that an average of 47 attempts are needed to achieve a 90% success rate of intubation [2]. A more recent study showed a success rate of 20.6% for medical students [8], which was lower than the result of our study (Macintosh group 66.7%).…”

Section: Discussioncontrasting

confidence: 82%

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Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope

2014

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BackgroundTracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one.MethodsTwenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt.ResultsIntubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P < 0.05). Duration of glottis exposure was significantly shorter in Airtraq group compared to Macintosh group (50 ± 19 s vs. 81 ± 27 s, P < 0.001). A grade I Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation in Airtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group.ConclusionsAirtraq laryngoscope is easier to master for novice personnel with a higher intubation success rate and shorter intubation duration compared with the Macintosh laryngoscope.Trial registrationTrial registration number is ChiCTR-TRC-13003987, approval date Dec 12, 2013.

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Section: Discussioncontrasting

confidence: 82%

“…Macintosh laryngoscope is the most widely used device to facilitate tracheal intubation [1], but is considered difficult to apply for novice personnel. It was reported that a 90% success rate requires 47 times of intubation practice [2]. Actually tracheal intubation could be divided into two main steps, glottis exposure and tube insertion.…”

Section: Introductionmentioning

confidence: 99%

Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope

2014

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“…However Wang and Yealy28 suggested that paramedics required 15–20 intubations to achieve a predicted 90% success rate. Mulcaster et al 29 suggested that an 80% probability of performing a ‘good’ intubation occurred after 35 attempts in a group of medical students, respiratory therapists and paramedics. The term ‘good’ referred to technique rather than successful intubation.…”

Section: Discussionmentioning

confidence: 99%

Success in physician prehospital rapid sequence intubation: what is the effect of base speciality and length of anaesthetic training?

Harris

Lockey

2011

Emergency Medicine Journal

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There is conflicting evidence concerning the role and safety of prehospital intubation, and which providers should deliver it. Success rates for physician-performed rapid sequence induction are reported to be 97-100%, with limited evidence of improved survival in some patient groups. However, there is also evidence that prehospital intubation and ventilation can do harm. Prospective data were recorded on the success of intubation, the quality of the laryngeal view obtained and the number of attempts at intubation. These data were then analysed by the grade of intubating doctor and whether the intubating doctor had a background in anaesthesia or emergency medicine. All groups had a similar success rate after two attempts at intubation. Doctors with a background in anaesthesia and consultant emergency physicians had a significantly better first-pass intubation rate than emergency medicine trainees. The quality of laryngeal view was significantly better in doctors with an anaesthetics background.

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“…The 'average' emergency medical service paramedic in the UK will see under five [19] out-of-hospital cardiac arrests a year, and in some regions far fewer than this. It is not surprising, therefore, that there is a significant complication rate associated with paramedic delivered pre-hospital intubation [10,11].…”

Section: Who Should Perform Endotracheal Intubation?mentioning

confidence: 99%