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Comparison of Video Versus Direct Laryngoscopy: A Prospective Prehospital Air Medical Services Study

Published:December 04, 2020DOI:https://doi.org/10.1016/j.amj.2020.10.008

      Highlights

      • Glottic visualization improved using videolaryngoscopy (VL), especially among patients with Cormack-Lehane (CL) grades 3 and 4 on direct laryngoscopy (DL).
      • Twenty-four patients had a CL grade 1 to 2 view with DL compared with 45 patients with VL.
      • Of the 25 patients with CL grade 3 and 4 view on DL, 22 were converted to grade 1 and 2 with VL.
      • The overall success rate with VL was 96%, and the first-pass success rate was 71%.
      • VL was functional 100% of the time, with a good or excellent image 98% of the time.

      Abstract

      Objective

      Videolaryngoscopy (VL) in the prehospital setting remains controversial, with conflicting data on its utility. We compared C-MAC VL (Karl Storz, Tuttlingen, Germany) versus direct laryngoscopy (DL) in the prehospital setting, recording the grade of the glottic view, first pass success (FPS), overall success, and equipment functionality.

      Methods

      We conducted a prospective observational study with a convenience sample of 49 adult patients who were intubated by flight crew nurses and paramedics using the C-MAC videolaryngoscope from April to November 2013. We compared Cormack-Lehane (CL) grades of view for DL and VL, intubation success rates, and equipment functionality.

      Results

      CL grades 1 or 2 were obtained with 24 patients (49%) with DL and 45 patients (92%) with VL. Of the 25 patients (51%) who had a CL grade 3 or 4 view on DL, 22 of those patients (88%) converted to a CL grade 1 or 2 with VL (P < .001). There was an overall success rate of 96% and an FPS rate of 71%. The C-MAC videolaryngoscope was functional during intubation 100% of the time.

      Conclusion

      VL improved glottic visualization compared with DL. The FPS and overall intubation success rates were similar to other published prehospital studies using VL. The C-MAC provided reliable, high-quality video despite demanding prehospital conditions.
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