Has Video Laryngoscopy Improved First Pass and Overall Intubation Success in the University of Florida Health Emergency Department?

Abstract

Airway management is an integral skill for emergency medicine physicians and is a significant part of residency training [1]. Direct laryngoscopy (DL) has been the mainstay of clinical practice for airway management. With the introduction of video laryngoscopy (VL), the emergency medicine (EM) community has embraced what was initially a difficult airway adjunct and is now moving towards becoming a standard of care, particularly for difficult airways [2-4]. The ultimate place of video laryngoscopy in EM airway management is at this time undecided. Airway management is a high risk procedure in EM populations; the risks associated with intubation in coding, hypotensive, or traumatized patients are significant and appropriately using the many adjuncts available can prevent an airway catastrophe [5-7]. Learning to properly use first line management techniques as well as adjunctive devices is an important part of everyday practice and residency training [8]. As an initial skill every EM resident learns is how to utilize DL for endotracheal intubation; however in the training period it can be difficult to communicate verbally what is being observed visually in the high stress environment of crash intubations. VL can serve as a method to allow increasing independence, as it offers the ability to practice DL for the operator and provides continuous indirect video for observers of the procedure, so feedback can occur in real time to the operator. VL has been shown to improve first pass success and time to intubation for novice operators but not for experienced operators [9]. Research has shown that repeated intubation attempts predict worse outcomes, namely hypoxic insults, cardiac arrest, aspiration, need for surgical airway, and increased mortality overall [10-12]. VL was re-introduced in this institution’s emergency department in January 2013 and since its role in airway management was relatively new, an evaluation of the use of VL in this ED was considered to be timely and important, given the fact that many attending providers were becoming accustomed to using this modality for all airways, including those deemed to not be critical in nature.