Abstract 3: Comparison of First Pass and Overall Success Rates of Intubation Between Direct Laryngoscopy, Bougie-assisted Laryngoscopy, and Video Laryngoscopy

Abstract

1: Airway Intubation Stationary vs. Transport David J. Olvera, FP-C, NREMT-P; Daniel Davis, MD, FACEP; Allen C. Wolfe Jr., MSN, RN, CNS, CFRN, CCRN, CMTE; Charles F. Swearingen, BS, NRP, FP-C. Air Methods Corporation Objectives: The most appropriate location to attempt an advanced airway in the prehospital setting has been a topic of discussion for many years. The purpose of this study is to explore intubation success for air medical flight crews during transport settings versus stationary settings. Methods: The study is a retrospective observational review of all patients requiring intubation in the prehospital setting with a national air medical transport company. After completion of a flight, the crew completed an airway continuous quality improvement (CQI) form documenting multiple aspects of the intubation. Upon completion of the form, the data were collated and analyzed using confidence intervals on first pass success as the primary outcome measure. The incidence of oxygen desaturation events was also reported. An intubation attempt was defined by the insertion of a laryngoscope blade into the patient's mouth. Successful placement required confirmation by quantitative capnography. Desaturation was defined as either 1) a decrease in SpO2 to 93% or below or 2) a decrease in oxygen saturation by 10% form the initial Sp02 value. Stationary intubation settings were defined as any intubation attempt made where the patient was not in transport when the intubation attempt was being attempted. Results: Intubation was attempted in a total of 3,254 patients during the study period, with success on the first attempt documented in 2,947 of these (90.6%, 95% CI 87.5%93.6%). Intubation was eventually successful in a total of 3,186 patients (97.9%, 95% CI 97.6%98.3%). A total of 2,835 first attempts of these occurred in a stationary setting, of which 2,565 were successful (90.5%, 95% CI 87.2 %93.8 %). The initial intubation attempt was made during transport in a total of 418 patients, with 382 intubated successfully on the first attempt (91.1%, 95% CI 82.5 %99.8%). Oxygen desaturation occurred during 676 of initial intubation attempts in a stationary setting (23.2%, 95% CI 21.9%-24.7%) and during 131 of initial intubation attempts during transport (30.6%, 95% CI 26.4%-34.8%). Conclusion: We document high first attempt intubation success rates for patients undergoing attempts in either a stationary setting or during transport. The desaturation rate was slightly higher during transport. This data suggests competency in either setting, however there is a greater complication of desaturation while intubating during flight. This analysis is limited by selection bias toward performing airway management in a stationary setting in patients anticipated to have difficult airways. Future studies should explore various factors predicting success during transport versus a