Abstract
PurposeThe aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy.MethodsA prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation.ResultsThe first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001).ConclusionAlthough no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.
Highlights
As multiple attempts for endotracheal intubation are associated with poor outcome for several patient categories, some have advocated the use of supraglottic airway devices instead of endotracheal intubation for non-physician
A total of 150 ambulance nurses rotate over 65 advanced life support (ALS) vehicles
Unexpected cancelation of the loan agreement by the manufacturer of the video laryngoscopes resulted in early termination of the study after these 219 patients were included
Summary
Obtaining sufficient training and exposure to safely perform endotracheal intubation in the field is one of the major challenges for paramedics or ambulance nurses, and prehospital doctors who are not anesthesiologists [1]. Reported first attempt success rates of prehospital endotracheal intubation vary substantially between different Emergency Medical Services (EMS) systems. A meta-analysis by Crewdson et al reported an overall success rate for intubation ranging from 62 to 100% for non-physicians [2]. Differences in training, experience and exposure with regard to advanced airway management are most likely the major contributing factors to the discrepancy between studies. As multiple attempts for endotracheal intubation are associated with poor outcome for several patient categories, some have advocated the use of supraglottic airway devices instead of endotracheal intubation for non-physician
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