Abstract 279: Variables Associated with Successful Intubation Attempts Using Video Laryngoscopy: A Preliminary Report in a Helicopter Emergency Medical Service

Abstract

Introduction: Multiple studies have demonstrated varying rates of successful endotracheal intubation (ETI) in the prehospital setting. Until the recent advent of video laryngoscopy, little information regarding the intubation process could be analyzed objectively by individuals other than the provider performing the ETI. We evaluated the association of variables recorded during video laryngoscopy and successful ETI attempts, defined as placing the endotracheal tube in the trachea. Methods: We retrospectively reviewed intubations performed by a single helicopter emergency medical service using a video larygoscope over an 8-month time period. Time intervals (e.g. attempt time) and intubation process variables (e.g. Cormack-Lehane view) were abstracted from all videos. We describe variables using means and standard deviations (continuous), medians with interquartile ranges (ordinal) and percentages (categorical). We examined the univariate associations between these variables and ETI success using logistic regression. Results: Results: We recorded 116 intubations during the study period. Twenty-nine recordings were either incomplete (n=26) or of insufficient quality for analysis (n=3). The remaining 87 videos represented 87 different patients with a total of 102 attempts at laryngoscopy. The first-pass success rate in this series was 76% (n=66) with 98% success within three attempts. Successful ETI attempts had lower entry to percentage of glottic opening (POGO) times (16.6 sec vs. 32.1 sec, p=0.013), entry to tube times (17.6 sec vs. 27.4 sec, p=0.04), higher POGO scores (76 vs. 39, p<0.001) and lower Cormack-Lahane views (1 vs. 3, p<0.001). Recognized esophageal intubation was more likely to occur during unsuccessful ETI attempts (43% vs. 8%, p<0.001). Conclusion: Video laryngoscopy provides a variety of time interval and intubation process variables regarding ETI that can be abstracted. Successful ETI attempts have significantly shorter entry to POGO times, entry to tube times, obtain better views of the glottic opening (POGO and C-L views) and a lower incidence of recognized esophageal intubation.