Abstract 33: Videolaryngoscopy Improves EMS Intubation Success in Cardiac Arrest Patients
Introduction: Emergency intubation by prehospital providers may be associated with a high rate of complications, including intubation failure, multiple attempts, and esophageal intubation, with increased errors noted in providers that perform intubation infrequently(1-3). Compared to conventional laryngoscopy (CL), the Glidescope (GS) videolaryngoscope (Verathon, Bothell WA) requires less training, and may be used safely by providers less skilled in intubation (4,5). In Howard County, Maryland, the intubation success rate by EMS personnel in 2009 was approximately 61%. The GS was considered as a potential tool for performance improvement. The purpose of this prospective, descriptive study was to determine the success rates and complications encountered after the implementation of GS for emergency intubation by EMS providers in Howard County.
Methods: After IRB and Maryland State EMS Board approval, GS Ranger units were acquired and incrementally placed on 12 EMS vehicles. Prior to implementation all paramedics received didactics and simulator training on the GS. Variables measured included indication for intubation, number of attempts, time to intubation, success rates, rescue airway requirements and intubating conditions. Conventional laryngoscopy (CL) and the King LTD were identified as rescue airway devices.
Results: A total of 42 emergency intubations for cardiac arrest were evaluated during the first 90 days of the study. Overall intubation success was 95% (p<0.05), with 60% first pass success when GS was used. The King LTD was used successfully in 1 patient. Only 2 patients did not have a secured airway on transport to the ED. Average time for a successful intubation attempt was 23 seconds. Of note, there were no esophageal intubations, dental or soft tissue injuries.
Conclusions: Following minimal training, prehospital providers intubate with a higher success rate when GS is available. These results should prompt further evaluation of videolaryngoscopy by EMS systems.
References: 1.Cobas, et al. Anesth Analg 2009:109, 489-93. 2.Katz et al. Ann Em Med 2001:37, 32-37. 3.Wang et al. Health Affairs 2006:25, 501-09 4.Nouruzi-Sedeh et al. Anesthesiology 2009:110, 32-37. 5.Rothfield et al. ASA Late Breaking Abstract #16, 2010.
- © 2011 by American Heart Association, Inc.