First-pass Success Rate Research Articles

Comparison of drugs used for intubation of pediatric trauma patients

PurposeRapid sequence intubation (RSI) drugs, such as propofol, affect clinical outcomes, but this has not been examined in the pediatric population. This descriptive study compares the outcomes associated with intubation drugs used in pediatric traumatic brain injury (TBI) patients. MethodsA retrospective chart review and descriptive analysis of intubated TBI patients, ages 0–17, admitted to Children's Hospital London Health Sciences Centre (LHSC) from January 2006–December 2016 was performed. ResultsOut of 259 patients intubated, complete data was available for 107 cases. Average injury severity score was 28; 46 were intubated at LHSC, 55 at primary care site, and 6 on scene. Intubation attempts were recorded in 87 of 107 paper charts. First-pass intubation success rate was 88.5%. Propofol (n = 21), midazolam (n = 31), etomidate (n = 13), and ketamine (n = 7) were the most commonly used intubation drugs. Paralytics were used in 50% of patients. Following use of propofol, Pediatric Adjusted Shock Index was increased as a result of worsening hypotension. Mean total hospital length of stay was 21 days with 7.5 days in ICU. Survival was 87%. ConclusionGreat variability exists in the use of induction agents and paralytics for RSI. Propofol was commonly used and is potentially associated with poorer clinical outcomes. Type of StudyRetrospective. Level of EvidenceIV

A prospective, randomized study comparing ultrasound versus fluoroscopic guided femoral arterial access in noncardiac vascular patients

ObjectiveThe aim of our prospective, single-center, randomized study was to compare the procedural outcomes and complication rates of ultrasound (US)-guided common femoral artery (CFA) access to fluoroscopic guidance in noncardiac procedures. MethodsA total of 635 patients undergoing femoral access for noncardiac diagnostic or interventional procedures were randomized 1:1 to receive either fluoroscopic or US-guided access. The primary end point of the study was successful CFA cannulation. Secondary end points included the first-pass success rate, time to sheath insertion, and accidental venipunctures rate. Both short (24 hours) and midterm (30-90 days postprocedure) access complications were assessed by practitioners blinded to patient randomization. ResultsSuccessful CFA cannulation occurred in 93% of US-guided procedures compared with 86% of fluoroscopy-guided access (P = .002). US guidance was associated with increased rates of first-attempt success (74% vs 42%; P < .001), fewer inadvertent venipunctures (2% vs 10 %; P < .001), and decreased median time to cannulation (80 vs 100 seconds; P < .001) compared with fluoroscopy. Rates of complications did not differ at 24 hours (1% vs 1%; P = .99) or 30 to 90 days (2% vs 4%; P = .15) in fluoroscopy vs US-guided access. When access was performed by vascular surgery trainees (residents and fellows), US guidance retained superior rates of successful CFA cannulation compared to fluoroscopy guided access (n = 298; 96% vs 89%; P = .03). Trainees' time to achieve CFA cannulation was similar to attendings' when using US guidance (median, 85 vs 77 seconds; P = .14); however, with fluoroscopy, trainees' times were significantly longer than those of attendings (137 vs 86 seconds; P = .001). ConclusionsIn comparison to fluoroscopy, US-guided CFA cannulation had a higher rate of success, faster cannulation, and fewer venipunctures in the absence of increased complications.

Comparison of the time to successful endotracheal intubation using the Macintosh laryngoscope or KingVision video laryngoscope in the emergency department: A prospective observational study.

OBJECTIVE:Intubation is a skill that must be mastered by the emergency physician (EP). Today, we have a host of video laryngoscopes which have been developed to make intubations easier and faster. It may seem that in a busy emergency department (ED), a video laryngoscope (VL) in the hands of an EP would help him intubate patients faster compared to the traditional direct laryngoscope (DL). Our goal was to compare the time taken to successfully intubate patients coming in ED using King Vision VL (KVVL) and DL.MATERIALS AND METHODS:This was a prospective observational study on patients coming to the ED requiring emergent intubation. They were allocated one to one alternatively into two groups – KVVL and DL. Accordingly, KVVL or DL intubations were carried out by the EPs. Time taken to intubate, first-pass success, and crossover between laryngoscopes were recorded.RESULTS:A total of 350 patients were enrolled in the study. Overall, mean time to intubate patients using the DL was 15.85 s (95% confidence interval [CI] 14.05–17.65), while the meantime with KVVL was 13.75 s (95% CI 12.32–15.18) (P = 0.084). The overall first-pass success rates with DL and KVVL were 89.94% and 85.16%, respectively (P = 0.076). A total of 7.43% (95% CI 5.12–10.66) patients had crossover between laryngoscopes.CONCLUSION:We found the KVVL to have a similar performance to the DL in terms of time for intubations and ease in difficult airways. We consider the KVVL a useful device for EDs to equip themselves with.

Ancillary protective gears in the COVID- 19 Era.

Ancillary protective gears in the COVID- 19 Era.

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

Background and Aim:Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices.Materials and Methods:The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device.Results:The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA.Conclusion:This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.

Modified long-axis in-plane ultrasound technique versus conventional palpation technique for radial arterial cannulation: A prospective randomized controlled trial.

A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults. We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications. Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.

Factors associated with first-pass success of emergency endotracheal intubation

Study objectiveEndotracheal intubation is frequently performed in emergency departments (EDs). First-pass success is important because repeated attempts are associated with poor outcomes. We sought to identify factors associated with first-pass success in emergency endotracheal intubation. MethodsWe analyzed emergency orotracheal intubations on adult patients in an ED located in South Korea from Jan. 2013 to Dec. 2016. Various operator-, procedure- and patient-related factors were screened with univariable logistic regression. Using variables with P-values less than 0.2, a multiple logistic regression model was constructed to identify independent predictors. ResultsThere were 1154 eligible cases. First-pass success was achieved in 974 (84.4%) cases. Among operator-related factors, clinical experience (OR: 2.93, 5.26, 3.80 and 5.71; 95% CI: 1.62–5.26, 2.80–9.84, 1.81–8.13 and 2.07–18.67 for PGY 3, 4 and 5 residents and EM specialists, respectively, relative to PGY 2 residents) and physician based outside the ED (OR: 0.10; 95% CI: 0.04–0.25) were independently associated with first-pass success. There was no statistically or clinically significant difference for first-pass success rate as determined by operator's gender (83.6% for female vs. 84.8% for male; 95% CI for difference: −3.1% to 5.8%). Among patient-related factors, restricted mouth opening (OR: 0.47; 95% CI: 0.31–0.72), restricted neck extension (OR: 0.57; 95% CI: 0.39–0.85) and swollen tongue (OR: 0.46; 95% CI: 0.28–0.77) were independent predictors of first-pass success. ConclusionsOperator characteristics, including clinical experience and working department, and patient characteristics, including restricted mouth opening, restricted neck extension and swollen tongue, were independent predictors of first-pass success in emergency endotracheal intubation.

Impact of a Critical Care Specialist Intervention on First Pass Success for Emergency Airway Management Outside the ICU.

There has been limited investigation into the procedural outcomes of patients undergoing emergent endotracheal intubation (EEI) by a critical care medicine (CCM) specialist outside the intensive care unit (ICU). We hypothesized that EEI outside an ICU would be associated with lower rates of first pass success (FPS) as compared to inside an ICU. We performed a retrospective cohort study of all adult patients admitted to our academic medical center between January 1, 2016, and July 31, 2018, who underwent EEI by a CCM practitioner. The primary outcome of FPS was identified in the EEI procedure note. Secondary outcomes included difficult intubation (> 2 attempts at laryngoscopy) and mortality following EEI. In total, 1958 patients (1035 [52.9%] inside ICU and 923 [47.1%]) outside an ICU) were included in the final cohort. Unadjusted rate of FPS was not different between patients intubated out of the ICU and patients intubated inside of the ICU (689 [74.7%] vs 775 [74.9%]; P = .91). There was also no difference in FPS between groups after adjusting for predictors of difficult intubation and baseline covariates (odds ratio: 0.95; 95% confidence interval, 0.75-1.2, P = .65). Mortality of patients undergoing EEI out of the ICU was higher at each examined time interval following EEI. For EEI done by CCM practitioners, rate of FPS is not different between patients undergoing EEI outside an ICU as compared to inside an ICU. Despite the lack of difference between rates of procedural success, patient mortality following EEI outside an ICU is higher than EEI inside an ICU at all examined time points during hospitalization.

The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults: a randomized controlled trial

BackgroundPrevious studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation.MethodsTwo hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups.ResultsFinally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments (P > 0.05). Compared with Group R, Group M had a better CLV (χ2 = 14.706, P = 0.001) and shorter times to glottis exposure (8.82 ± 2.04 vs 12.38 ± 1.81; t = 14.94; P < 0.001) and tracheal intubation (37.19 ± 5.01 vs 45.23 ± 4.81; t = 13.25; P < 0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 = 0.074; P = 0.446) and intubation procedure time (29.86 ± 2.56 vs 30.46 ± 2.97, t = 1.75, P = 0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference (P > 0.05).ConclusionAlthough the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation.Trial registrationThe study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).

Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System.

IntroductionPrehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure.MethodsUsing data from a large, metropolitan, fire-based EMS service, we performed an observational study of pediatric patients with respiratory failure or cardiac arrest who were transported by EMS before and after implementation of an evidence-based airway management protocol inclusive of the addition of the EGA. The primary outcome was change in frequency of intubation attempts when paired with an initial EGA. Secondary outcomes included EGA and intubation success rates and patient survival to hospitalization and discharge.ResultsWe included 265 patients age <16 years old, with 142 pre- and 123 post-protocol change. Patient demographics and event characteristics were similar between groups. Intubation attempts declined from 79.6% pre- to 44.7% (p<0.01) post-protocol change. In patients with an intubation attempt, overall intubation success declined from 81.4% to 63.6% (p<0.01). Post-protocol change, an EGA was attempted in 52.8% of patients with 95.4% success.ConclusionImplementation of an evidenced-based airway management algorithm for pediatric patients, inclusive of an EGA device for all age groups, was associated with fewer prehospital intubations. Intubation success may be negatively impacted due to decreases in procedural frequency.

Advancing mitochondrial genome data interpretation in missing persons casework

Massively parallel sequencing techniques have made possible the adoption of mitogenome sequencing for missing persons casework. In order to expand the family pedigree and population data necessary for sequence comparisons and statistical analysis, complete mitochondrial genome (mitogenome) haplotypes were generated by the Armed Forces Medical Examiner System’s Armed Forces DNA Identification Laboratory using an automated laboratory workflow and robust analysis pipeline. Over 600 CEPH family pedigree samples from 87 lineages were processed in order to characterize the expected number of differences in mitogenome sequences between maternal relatives. Although stochastic artifacts in the CEPH cell lines elevated the point heteroplasmy rate three-fold compared to population sample data (1.8 vs. 0.46 point heteroplasmies per individual, on average), the CEPH family sequences exhibited a maximum of two substitutions between any two maternal relatives in nearly 500 generational events. The family study furthermore showed that elevating the variant detection threshold may create false substitutions at heteroplasmic sites. Results from an initial 2000 reference database samples indicate a first-pass success rate of 85%, with 97% unique mitogenome haplotypes. These data demonstrate advancements made toward the interpretation of mitogenome sequence data in missing persons casework.

Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine.

Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine.

Predictors of Balloon Guide Catheter Assistance Success in Stent-retrieval Thrombectomy for an Anterior Circulation Acute Ischemic Stroke.

IntroductionMechanical thrombectomy has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS) in well-selected patients. Although many devices and strategies exist, the use of a balloon-tip guide catheter (BGC) with stent-retriever (SR) may hold several advantages. We aim to assess the efficacy and identify predictors of technical success of this unique approach.MethodsFrom our prospectively maintained database, we identified consecutive cases in which a BGC was used for stent-retriever thrombectomy in anterior circulation LVO between 2015 and 2016. Baseline and procedural characteristics were captured and analyzed. Predictors of technical and clinical outcomes were identified by multivariable logistic regression analysis.ResultsNinety-three patients with AIS-LVO were treated with BGC-assisted mechanical thrombectomy. The mean age was 71 years old (SD 14), with 49.5% male (n=46). Pre-operative IV-tPA was administered in 55.9% (n=52) of cases. The most common location of occlusive thrombus was M1 (64.5%, n=60). Successful recanalization (mTICI=2b-3) was achieved in 86.0% (n=80) of cases while complete revascularization (mTICI-3) was achieved in 56.5% (n=52). There was a first-pass success rate of 52.7% (n=49). At discharge, 38.7% of the patients were functionally independent (mRS≤2). Multivariate analysis revealed that the middle cerebral artery location was strongly predictive of first-pass success, resulting in mTICI =2b revascularization (OR 7.10, p=0.018). Additionally, female gender (OR 2.85, p=0.042) and decreasing mTICI were associated with a poor clinical outcome (mRS≥4; OR 1.76, p=0.008).ConclusionsBGC assistance in stent retrieval thrombectomy is safe and effective for AIS due to anterior circulation LVO. Further investigation is required to elucidate the optimal treatment strategy based on patient and disease characteristics.

A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach

ObjectiveThe purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED). MethodsThis was an unblinded, prospective, randomized trial performed by emergency medicine (EM) clinicians at a single academic ED. Eligible participants were randomized to ultrasound-guided PIV placement with or without the use of a guidewire. PIV access was obtained using the Accucath™ 20 gauge × 5.7 cm catheters by way of deployment or non-deployment of the guidewire. Primary outcome measure was first-pass success rate and secondary outcomes included number of attempts, complication rates, and clinician reported ease of insertion. ResultsSeventy patients were enrolled and 69 were included in the final analysis. Thirty-four participants were randomized to use of guidewire and 35 to no guidewire. First-pass success rates were similar with and without guidewire use, 47.1% vs. 45.7%, (p = 0.9). There were no differences found in median number of attempts between the two techniques, 2 (IQR 1–2) vs 2 (IQR 1–2), (p = 0.60). The complication rates were similar, 15% vs. 29% (p = 0.25). Clinicians reported no difference in ease of insertion between methods on a 5-point Likert Scale, mean 2.6 vs 2.7 (p = 0.76). DiscussionIn this pilot study comparing ultrasound-guided PIV placement in ED patients using an integrated guidewire versus no guidewire, there was no significant difference in first-pass success, number of attempts, or complication rates. This study provides preliminary data for further investigations.

First-Pass Success Intubations Using Video Laryngoscopy Versus Direct Laryngoscopy: A Retrospective Prehospital Ambulance Service Study

ObjectiveIn emergency medicine, endotracheal intubation is the gold standard for airway management. First-pass intubation success is beneficial because it secures the patient airway more quickly and avoids complications associated with repeated attempts, such as bleeding and swelling of soft tissue. The key to first-pass success is the ability to visualize the laryngeal inlet. Visualization can be accomplished using traditional direct laryngoscopy or video laryngoscopy. The purpose of our study was to compare the rate of successful first-pass endotracheal intubations using a video laryngoscope with that using a direct visualization laryngoscope in a prehospital emergency setting. MethodsWe retrospectively reviewed data that had been prospectively collected in our emergency department regarding patients who underwent endotracheal intubation performed by personnel from a single local ambulance service from January 1, 2014, through December 31, 2015. ResultsOne hundred eighty-one patients were intubated using video laryngoscopy and 115 using direct visualization laryngoscopy. The first-pass endotracheal intubation success rate using video laryngoscopy was 12.6% higher than with direct laryngoscopy. ConclusionThis retrospective study shows that video laryngoscopy had a higher first-pass success rate than direct laryngoscopy. This is promising because decreasing failure rates provide better patient outcomes.

A comparison of the king vision® and glidescope® video intubation systems in patients at risk for difficult intubation

BackgroundOne factor that contributes to the difficulty during intubation is poor visualization of the airway anatomy during laryngoscopy. AimTo compare the efficacy and first-pass success rate of the King Vision® Video Laryngoscopes against the GlideScope® Video Laryngoscope in patients with anticipated difficult airways. Methods225 adult patients scheduled for surgery requiring general anesthesia and tracheal intubation that met ≥2 of the following inclusion criteria: Mallampati classification (MP) III-IV, inter-incisor distance < 4 cm, neck circumference > 43 cm, and/or thyromental distance < 6 cm were randomized into 3 groups: GlideScope® (GS; n = 75), King Vision® – Channeled (KV-Ch; n = 75), and King Vision® – Non-Channeled (KV-NCh; n = 75). Intubation time and number of intubation attempts were collectively considered as the primary objective, amongst resident anesthesiologists. ResultsThe rate of success of tracheal intubation was 96% for GS, 81.3% for KV-Ch, and 96% for KV-NCh. Furthermore, first-pass success was highest for the KV-NCh at 89.3%, with GS and KV-Ch having a significant difference (P = 0.0083). ConclusionThe GS and KV-NCh performed similarly in facilitating successful tracheal intubation during the first attempt. In contrast, the KV-Ch was less successful overall.

A comparison of airway management devices in simulated entrapment-trauma: a prospective manikin study

IntroductionIn the patient entrapped after a motor vehicle collision (MVC), advanced airway management may need to be performed before extrication. The aim of this study was to compare four airway management devices utilized by paramedics in a simulated entrapped patient.MethodsTwenty-six paramedics performed advanced airway management on a manikin seated in the driver’s seat (right side) of a car. Access was through the opened door only. The airway devices were the Macintosh laryngoscope and the Airtraq optical laryngoscope to facilitate the endotracheal intubation (ETI), the laryngeal mask airway (LMA) Supreme and the laryngeal tube (LT). Time to first successful ventilation and number of attempts required for successful placement were measured. Following each placement, participants rated the degree of difficulty. For ETI, participants ranked the achieved glottic view using Cormack-Lehane grades (CLG). Finally, participants were asked which airway management device they preferred.ResultsThe LMA Supreme had the shortest mean time to first successful ventilation (16.7 s, CI [0.95] 14.9–18.6). Insertion of the LMA Supreme and ETI with the Macintosh laryngoscope had 100% first-attempt success. The LMA Supreme was rated least difficult to insert (mean score 1.7/10 (CI [0.95] 1.2–2.1)). Compared to the Macintosh, the Airtraq laryngoscope facilitated superior laryngoscopy (CLG I view 46.2% and 80.8%, respectively). Most participants (10/26; 38%) chose the Macintosh laryngoscope as their preferred technique, followed closely by the LMA Supreme (9/26; 35%).ConclusionThe LMA Supreme took the least amount of time and was the easiest to be inserted. Extraglottic airway devices may be beneficial alternative airway management devices to be considered by paramedics in the entrapped patient. Endotracheal intubation using the Macintosh laryngoscope was performed competently by participating paramedics. The Airtraq enabled superior laryngoscopy but resulted in poorer first-pass success rate.

Effect of the introduction of C-MAC videolaryngoscopy on first-pass intubation success rates for emergency medicine registrars.

The present study investigated the impact of introducing C-MAC videolaryngoscopy as the standard method of visualising glottic structures on first-pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C-MAC videolaryngoscopy were compared. The primary outcome was first-pass intubation success rates by EM registrars. Secondary outcomes were first-pass success rates by all intubators, and incidence of any complication of intubation. There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first-pass success from 59.2% (95% confidence interval [CI] 44.1-68.8%) to 85.1% (95% CI 76.0-91.2%, P < 0.001) after the introduction of C-MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06-5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85-10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C-MAC (28.9%, 95% CI 19.9-40.0% prior to C-MAC introduction; 16.1%, 95% CI 9.7-25.3% after; P = 0.048). This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators.

Association of patient age with first pass success in out-of-hospital advanced airway management

BackgroundFirst pass advanced airway insertion success is associated with fewer adverse events. We sought to compare out-of-hospital endotracheal intubation (ETI) and supraglottic airway (SGA) first-pass success (FPS) rates between adults and children in a national cohort of EMS agencies. MethodsWe analyzed data from 2017 using a national cohort of 731 EMS agencies. Using multivariable logistic regression, we compared the odds of ETI and SGA FPS between adult (age >14 years) and pediatric (age ≤14 years) patients, adjusting for gender, ethnicity, indication, and drug facilitation. We performed a sensitivity analysis of all patients using age as a continuous variable for both ETI and SGA FPS. Finally, we calculated the odds of FPS using all possible age break points between 10 and 18 years old. ResultsA total of 29,368 patients (28,846 adults and 522 children) received ETI (22,519) or SGA (6849). ETI FPS was higher in adults than children; 72.7% vs, 58.5%, (OR 1.80, 95% CI 1.49–2.17). SGA FPS was similar between adults and children; 89.8% vs 84.6%, (OR 1.63, CI 0.70–3.31). When analyzed as a continuous variable, ETI FPS remained associated with age in years: OR 1.007 (CI 1.006–1.009) and SGA FPS showed no significant association with age: OR 0.999 (0.995–1.004). The OR for ETI FPS were higher in adults than pediatrics at all potential age break points between 10 and 18 years old. The OR for SGA FPS was significantly more likely in adults than pediatrics using 16 as a break point but not significantly different between adults and pediatrics using any other age break point. ConclusionIn this national cohort of out-of-hospital patients, ETI FPS was higher for adults than children. SGA FPS did not significantly vary with age. SGA FPS was higher than ETI FPS at all ages.

WITHDRAWN: Does physician gender have a significant impact on first-pass success rate of emergency endotracheal intubation?

WITHDRAWN: Does physician gender have a significant impact on first-pass success rate of emergency endotracheal intubation?