{"pk":39983,"title":"Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study","subtitle":null,"abstract":"<p><strong>Introduction:</strong> Upright intubation is essential for managing difficult airways but can be challenging, especially for less experienced clinicians. Face-to-face intubation may lower first-pass success rates due to unfamiliar orientation. New videolaryngoscope devices have the potential to improve intubation success. We aimed to compare first-pass success rates, intubation duration, and glottic view between the right-rear and face-to-face approaches, using channeled videolaryngoscope, hyperangulated videolaryngoscope, and video stylet for upright intubation.</p>\n<p><strong>Methods:</strong> We conducted a cross-over manikin simulation study involving 30 participants—19 attending physicians, six residents, and five nurse practitioners—to compare the efficacy of these devices to a standard Macintosh videolaryngoscope, using both right-rear and face-to-face approaches.</p>\n<p><strong>Results: </strong>We used Cox regression analysis to calculate hazard ratios for the following variables: first-pass success rate; intubation time; glottic view quality (Cormack-Lehane grade [C-L]); and percentage of glottis opening score (POGO]. The right-rear approach demonstrated a substantial improvement in first-pass success rates compared to face-to-face, with rates of 93% vs 78% and a hazard ratio of 2.10 (95% confidence interval 1.58-2.80). Additionally, both the video stylet and channeled videolaryngoscope techniques further optimized first-pass success rates and enhanced glottic visualization, achieving a CL grade I view and POGO scores of 100%, even in the inverted face-to-face orientation. These devices outperformed the standard Macintosh and hyperangulated videolaryngoscopes.</p>\n<p><strong>Conclusion:</strong> The right-rear approach was associated with higher first-pass success rates and provided a more familiar orientation for operators during upright intubation. Video stylets and channeled videolaryngoscopes also contributed to improved success rates, shorter intubation times, and better glottic visualization.</p>","language":"eng","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":"upright position"},{"word":"face-to-face approach"},{"word":"right-rear approach"},{"word":"videolaryngoscope"},{"word":"videostylet"},{"word":"Macintosh curve"},{"word":"channeled videolaryngoscope"},{"word":"hyperangulated videolaryngoscope"},{"word":"face-to-face achanneled videolaryngoscope"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4348h9nb","frozenauthors":[{"first_name":"Cheng-Wei","middle_name":"","last_name":"Tseng","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan","department":""},{"first_name":"Chung-Shiung","middle_name":"","last_name":"Wen","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan","department":""},{"first_name":"Sheng-Han","middle_name":"","last_name":"Yu","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan","department":""},{"first_name":"Yung-Cheng","middle_name":"","last_name":"Su","name_suffix":"","institution":"Chiayi Christian Hospital, Ditmanson Medical Foundation, Department of Emergency, Chiayi County, Taiwan","department":""},{"first_name":"Shu-Sheng","middle_name":"","last_name":"Li","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan","department":""},{"first_name":"Hsin-Ling","middle_name":"","last_name":"Chen","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan","department":""},{"first_name":"Tzu-Yao","middle_name":"","last_name":"Hung","name_suffix":"","institution":"Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, Taiwan; National Yang Ming Chiao Tung University, Faculty of Medicine, Taipei City, Taiwan; CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan","department":""}],"date_submitted":"2024-11-24T06:41:38.193000Z","date_accepted":"2025-03-28T11:47:43.576000Z","date_published":"2025-07-10T23:33:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/39983/galley/37043/download/"}]}