Abstract 93: GlideScope Video Laryngoscopic vs Macintosh Laryngoscopic Intubation During Cardiopulmonary Resuscitation: An Observational Study and Propensity Score Matching Analysis

Abstract

Introduction: The use of video laryngoscope during cardiopulmonary resuscitation (CPR) has not been extensively studied. A randomized controlled trial comparing the efficacy between video and direct laryngoscopy during CPR is logistically difficult. The objective of this study was to determine whether the first-attempt success rate of intubation using GlideScope video laryngoscope (GVL) is different to Macintosh laryngoscope (MAC) during CPR. Hypothesis: We hypothesized that the first-attempt success rate of intubation using GVL would be higher than MAC during CPR. Methods: This was an observational study using a multicenter airway registry data of six emergency departments (EDs) following current CPR guidelines - minimize interruptions in chest compressions. Adults of out-of-hospital cardiac arrest intubated in the EDs from March 2006 to December 2010 were enrolled. The primary outcome was success with first attempt. Secondary outcome was intubation failure. An attempt was defined as the introduction of the laryngoscope into the mouth. Failure was defined as an esophageal intubation, changing to a different device or intubator, or more than three attempts. To reduce the effect of selection bias and potential confounding, we performed rigorous adjustment for significant differences in patient and intubator factors using a propensity-score (PS) matching analysis. The adjusted odds ratio (OR) and its 95% confidence interval (CI) for the outcomes between the laryngoscopes were calculated. Results: A total of 1867 eligible patients were enrolled in this study. Of those patients, GVL was used for initial attempt in 180 (9.6%). Overall first-attempt success rate were 86.1% in GVL group and 80.9% in MAC group ( p =0.090), but failure rate was significantly different between two groups (GVL vs. MAC; 7.2% vs. 14.9%, p =0.006) in crude analysis. Using PS matching, 177 patients were equally assigned to each group. The adjusted OR for the first-attempt success and failure rate in GVL group compared to MAC group was 1.37 (95% CI 0.76-2.45) and 0.46 (95% CI 0.23-0.93), respectively. Conclusions: The first-attempt success rates of intubation during CPR were not significantly different between GVL and MAC. However, intubation failure rate of GVL was lower than MAC.