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- Title
The Impact of a Soiled Airway on Intubation Success in the Emergency Department When Using the GlideScope or the Direct Laryngoscope.
- Authors
Sakles, John C.; Corn, G. Judson; Hollinger, Patrick; Arcaris, Brittany; Patanwala, Asad E.; Mosier, Jarrod M.; Reardon, Rob
- Abstract
Background The objective was to determine the impact of a soiled airway on firstpass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department ( ED). Methods Data were prospectively collected on all patients intubated in an academic ED from July 1, 2007, to June 30, 2016. Patients ≥ 18 years of age, who underwent rapid sequence intubation by an emergency medicine resident with the GlideScope or the direct laryngoscope, were included in the analysis. Data were stratified by device used (GlideScope or direct laryngoscope). The primary outcome was firstpass success. Patients were categorized as those without blood or vomitus ( CLEAN) and those with blood or vomitus ( SOILED) in their airway. Multivariate regression models were developed to control for confounders. Results When using the GlideScope, the firstpass success was lower in the SOILED group (249/306; 81.4%) than the in CLEAN group (586/644, 91.0%; difference = 9.6%; 95% confidence interval [ CI] = 4.7%-14.5%). Similarly, when using the direct laryngoscope, the firstpass success was lower in the SOILED group (186/284, 65.5%) than in the CLEAN group (569/751, 75.8%; difference = 10.3%; 95% CI = 4.0%-16.6%). The SOILED airway was associated with a decreased firstpass success in both the GlideScope cohort (adjusted odds ratio [ aOR] = 0.4; 95% CI = 0.3-0.7) and the direct laryngoscope cohort ( aOR = 0.6; 95% CI = 0.5-0.8). Conclusion Soiling of the airway was associated with a reduced firstpass success during emergency intubation, and this reduction occurred to a similar degree whether using either the GlideScope or the direct laryngoscope.
- Subjects
ACADEMIC medical centers; AIRWAY (Anatomy); CONFIDENCE intervals; HOSPITAL emergency services; LARYNGOSCOPY; LONGITUDINAL method; EVALUATION of medical care; MEDICAL technology; MULTIVARIATE analysis; REGRESSION analysis; TRACHEA intubation; ACQUISITION of data; PATIENT selection; DATA analysis software; ODDS ratio
- Publication
Academic Emergency Medicine, 2017, Vol 24, Issue 5, p628
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.13160