Abstract 12096: Interruptions of Views Are Associated With Failed Endotracheal Intubation and Shallow Laryngoscopic Blade Position is Associated With Longer Attempt Time in the Prehospital Settings

Abstract

Introduction: Endotracheal intubation (ETI) is an essential skill for the critically ill patient. Prehospital ETI can be complicated by austere conditions and limited support, sometimes resulting in failure to intubate. Video laryngoscopy (VL) is primary a technical augmentation to facilitate ETI. VL also provides opportunity for evaluation of the technique or airway conditions during ETI. Hypothesis: We tested whether clinical variables were associated with failed ETI and longer attempt time performed by prehospital providers. Methods: A retrospective case control study was conducted with patients transported from Dec 2009 to Feb 2015 by air critical care medical service. The VL used in the study has the ability to display and digitally record the procedure which can be reviewed after the incident. An ETI attempt was defined by placing the VL into patient’s mouth. We obtained outcome variables and blade tip position during the procedure. The primary outcome measure was successful ETI attempt and the secondary outcome measure was time to accomplish a successful attempt. A multivariable logistic regression model was used for the primary outcome. Cox proportional hazards regression analysis was used for the secondary outcome. Results: 304 intubation attempts in 268 patients were analyzed. There were 244 successful attempts and 60 failed attempts. Blade tip generally moved from shallower position to vallecular. 53.5% of the attempt was at shallow position 4 sec after the initiation of the procedure. Longer attempt time (p = 0.02; OR 0.98), higher Cormak-Lehane view (p < 0.001; OR 0.22), bodily fluids obstructing the view (p = 0.007; OR 0.26), and VL equipment error (p < 0.001; OR 0.13) were associated with failed attempts. The bodily fluids obstructing the view (p < 0.001; HR 0.51), and VL equipment error (p = 0.003; HR 0.42) were also associated with longer ETI attempt time. Shallow placement of blade tip at 4 seconds of intubation (p < 0.001; HR 0.40) was another factor associated with longer ETI attempt time. Conclusions: The variables interrupting the view during ETI were the major concerns associated with failed ETI attempts. The result also demonstrated high frequency of the shallow blade tip position and longer attempt time in this situation.