Abstract
BackgroundPre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge.MethodsDuring a 3.5 year period, the GS-R was available to be used either as the primary or backup tool for pre-hospital intubation by anaesthesia trained EP with limited expertise using angulated videolaryngoscopes.ResultsDuring this period 672 patients needed pre-hospital intubation of which the GS-R was used in 56 cases. The overall GS-R success rate was 66 % (range of 34–100 % among EP). The reasons for difficulties or failure included inexperience of the EP with the GS-R, impaired view due to secretion, vomitus, blood or the inability to see the screen in very bright environment due to sunlight.ConclusionSpecial expertise and substantial training is needed to successfully accomplish tracheal intubation with the GS-R in the pre-hospital setting. Providers inexperienced with DL as well as video-assisted intubation should not expect to be able to perform tracheal intubation easily just because a videolaryngoscope is available. Additionally, indirect laryngoscopy might be difficult or even impossible to achieve in the pre-hospital setting due to impeding circumstances such as blood, secretions or bright sun-light. Therefore, videolaryngoscopes, here the GS-R, should not be considered as the “Holy Grail” of endotracheal intubation, neither for the experts nor for inexperienced providers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0069-2) contains supplementary material, which is available to authorized users.
Highlights
Pre-hospital endotracheal intubation is more difficult than in the operating room (OR)
We evaluated the use of the GlideScope®Ranger (GS-R, Verathon Inc., Bothell, WA, USA), a portable version of the GlideoScope® videolaryngoscope (GS-VL) during consecutive pre-hospital intubations performed by physician anaesthesiologists, who were experienced in emergency and advanced airway management, but had individually differing levels of expertise with the GS-VL
The GS-R was not used as a rescue device in case of a failed tracheal tube placement primarily attempted via Direct laryngoscopy (DL)
Summary
Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. Several authors have emphasized the challenges as well as the alarmingly high failure rates for pre-hospital endotracheal tube (ETT) placement [1,2,3,4]. Other authors have described more favourable success rates when pre-hospital airway management was performed by anaesthesiologists or skilled emergency physicians [5,6,7]. That the GlideScope® videolaryngoscope (GS-VL, Verathon Inc., Bothell, WA, USA), provides significant better exposure of the laryngeal structures in normal and difficult to manage airways. One study has demonstrated that acquiring intubation skills by untrained medical personal was enhanced by GS-VL use [14]
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