Abstract 17461: Ambiguity of the Self-report Description of Cormack-lehane View Grading in the Prehospital Settings
Introduction: Cormack-Lehane (C-L) view is common method for grading difficult endotracheal intubation (ETI). Although until recently, C-L view could not be analyzed by the individuals other than the provider performing ETI. Video laryngoscopy (VL) is a relatively new device primarily to facilitate ETI. VL can also provide recorded data for objective review of the technique.
Hypothesis: We tested whether C-L view evaluated by prehospital provider (paramedic/nurse) correlates with the true C-L view verified by with VL video recorded data.
Methods: A retrospective review of the patients transported from Mar 2010 to Oct 2015 by air critical care medical service. The VL used in the study has the ability to display and digitally record the procedure which can be reviewed after the incident. True C-L view was confirmed by medical doctors using VL recorded data. Prehospital provider C-L view was obtained from self-reported medical charts description. We defined prehospital provider C-L view grading of I or II as “easy view” and provider C-L view grading of III or IV as “difficult view”. For the primary outcome, Cohen’s kappa was used to evaluate the reliability of prehospital provider C-L view. For the secondary outcome, characteristics between “easy view” and “difficult view” were compared.
Results: Results: 236 patients were included in the study. Overall ETI success rate was 93%. True C-L view grades were (I: 159 [67%], II: 72 [31%], III: 4 [2%], IV: 1 [0%]) whereas, prehospital providers graded (I: 129 [55%], II: 80 [34%], III: 24 [10%], IV: 3 [1%]). There was 57% agreement: kappa 0.21 (p < 0.0001) between prehospital provider C-L view and true C-L view. Although true C-L view were not significantly different between “easy view” group and “difficult view” group (1 [1-2] vs 1 [1-2], p = 0.33), total attempt time for ETI (59±35 s vs 26±27 s, p < 0.0001) and attempt number (1 [1-1] vs 1 [1-2], p < 0.0001) were significantly higher; success rate was significantly lower in “difficult view” group (96% vs 71%, p < 0.0001).
Conclusions: C-L view grading only had “fair” agreement between prehospital provider and VL video recorded data. Self-reported description of C-L view grading may contain recall bias and observer bias influenced by ETI difficulty besides true C-L view.
Author Disclosures: H. Naito: None. F.X. Guyette: None. C. Martin-Gill: None. A. Nakao: None. C.W. Callaway: None.
- © 2016 by American Heart Association, Inc.