Impact of Video Laryngoscopy on Advanced Airway Management by Critical Care Transport Paramedics and Nurses Using the CMAC Pocket Monitor.

Bradley Boehringer,Peter V R Tilney,Michael Choate,Thomas Judge,Shelley Hurwitz

doi:10.1155/2015/821302

Abstract

Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08.

Highlights

Prehospital advanced airway management by paramedics and nurses has become an increasingly relevant and debated topic
Research has persistently demonstrated that failure rates of prehospital transport personnel are far higher and fraught with more complications compared to those of in-hospital personnel or physician based helicopter EMS (HEMS) colleagues [1, 2]
In cases such as cardiac arrest, recently published data is beginning to show that management with supraglottic airways or a bag-valve mask may be effective, especially in cases where immediate airway protection by endotracheal tube (ETT) is unlikely or apt to be accompanied by adverse events [3,4,5,6]

Summary

Introduction

Prehospital advanced airway management by paramedics and nurses has become an increasingly relevant and debated topic. Research has persistently demonstrated that failure rates of prehospital transport personnel are far higher and fraught with more complications compared to those of in-hospital personnel or physician based helicopter EMS (HEMS) colleagues [1, 2]. In cases such as cardiac arrest, recently published data is beginning to show that management with supraglottic airways or a bag-valve mask may be effective, especially in cases where immediate airway protection by endotracheal tube (ETT) is unlikely or apt to be accompanied by adverse events [3,4,5,6]. Video laryngoscopy has demonstrated shorter entry to POGO (percentage of glottic opening) and entry to tube times, improved glottic view, and lower incidence of esophageal ETT placement [19,20,21,22]

Methods

Results

Discussion

Conclusion