{"pk":16183,"title":"Direct vs Video Laryngoscopy for Difficult Airway Patients in the Emergency Department: A National Emergency Airway Registry Study","subtitle":null,"abstract":"Introduction:\n Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways. \nMethods:\n We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016–December 2018). Variables included demographics, indications, methods, medications, devices, difficult airway characteristics, success, and adverse events. We included adult ED patients intubated with VL or DL who had difficult airways identified by gestalt or anatomic predictors. We stratified VL by hyperangulated (HAVL) vs standard geometry VL (SGVL). The primary outcome was FPS, and the secondary outcome was comparison of adverse event rates between groups. Data analyses included descriptive statistics with cluster-adjusted 95% confidence intervals (CI).\nResults:\n Of 18,123 total intubations, 12,853 had a predicted or identified anatomically difficult airway. The FPS for difficult airways was 89.1% (95% CI 85.9-92.3) with VL and 77.7% (95% CI 75.7-79.7) with DL (P <0.00001). The FPS rates were similar between VL subtypes for all difficult airway characteristics except airways with blood or vomit, where SGVL FPS (87.3%; 95% CI 85.8-88.8) was slightly better than HAVL FPS (82.4%; 95% CI, 80.3-84.4). Adverse event rates were similar except for esophageal intubations and vomiting, which were both less common in VL than DL. Esophageal intubations occurred in 0.4% (95% CI 0.1-0.7) of VL attempts and 1.5% (95% CI 1.1-1.9) of DL attempts. Vomiting occurred in 0.6% (95% CI 0.5-0.7) of VL attempts and 1.4% (95% CI 0.9-1.9) of DL attempts.\nConclusion:\n Analysis of the NEAR database demonstrates higher first-pass success with VL compared to DL in patients with predicted or anatomically difficult airways, and reduced rate of esophageal intubations and vomiting.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"intubation, difficult airway, video laryngoscopy, direct laryngoscopy, first-pass success"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/88d648jj","frozenauthors":[{"first_name":"Brandon","middle_name":"T.","last_name":"Ruderman","name_suffix":"","institution":"Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Martina","middle_name":"","last_name":"Mali","name_suffix":"","institution":"Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas","department":"None"},{"first_name":"Amy","middle_name":"","last_name":"Kaji","name_suffix":"","institution":"Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas","department":"None"},{"first_name":"Robert","middle_name":"","last_name":"Kilgo","name_suffix":"","institution":"Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas","department":"None"},{"first_name":"Susan","middle_name":"","last_name":"Watts","name_suffix":"","institution":"Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas","department":"None"},{"first_name":"Radosveta","middle_name":"","last_name":"Wells","name_suffix":"","institution":"Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas","department":"None"},{"first_name":"Alexander","middle_name":"T.","last_name":"Limkakeng, Jr.","name_suffix":"","institution":"Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Joseph","middle_name":"B.","last_name":"Borawski","name_suffix":"","institution":"Duke University Medical Center, Department of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Andrea","middle_name":"E.","last_name":"Fantegrossi","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Ron","middle_name":"M.","last_name":"Walls","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Calvin","middle_name":"A.","last_name":"Brown, III","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2021-12-07T07:55:41Z","date_accepted":"2021-12-07T07:55:41Z","date_published":"2022-08-19T22:33:52Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/16183/galley/8114/download/"}]}