A Comparison of GlideScope Video Laryngoscopy Versus Direct Laryngoscopy Intubation in the Emergency Department

Authors

  • Timothy F. Platts-Mills MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Danielle Campagne MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Brian Chinnock MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Brandy Snowden MPH,

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Larry T. Glickman PhD,

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Gregory W. Hendey MD

    1. From the Department of Emergency Medicine, University of California San Francisco, Fresno, CA. Dr. Platts-Mills is now at the Department of Emergency Medicine, University of North Carolina Chapel Hill, NC.
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  • Presented at the American College of Emergency Physicians Scientific Assembly, Chicago, IL, October 2008.

  • No funding or support was received for this study, and none of the authors have a relationship with the maker of the device studied.

  • A related commentary appears on page 908.

Timothy F. Platts-Mills, MD; e-mail: tplattsm@med.unc.edu. Reprints will not be available.

Abstract

Objectives:  The first-attempt success rate of intubation was compared using GlideScope video laryngoscopy and direct laryngoscopy in an emergency department (ED).

Methods:  A prospective observational study was conducted of adult patients undergoing intubation in the ED of a Level 1 trauma center with an emergency medicine residency program. Patients were consecutively enrolled between August 2006 and February 2008. Data collected included indication for intubation, patient characteristics, device used, initial oxygen saturation, and resident postgraduate year. The primary outcome measure was success with first attempt. Secondary outcome measures included time to successful intubation, intubation failure, and lowest oxygen saturation levels. An attempt was defined as the introduction of the laryngoscope into the mouth. Failure was defined as an esophageal intubation, changing to a different device or physician, or inability to place the endotracheal tube after three attempts.

Results:  A total of 280 patients were enrolled, of whom video laryngoscopy was used for the initial intubation attempt in 63 (22%) and direct laryngoscopy was used in 217 (78%). Reasons for intubation included altered mental status (64%), respiratory distress (47%), facial trauma (9%), and immobilization for imaging (9%). Overall, 233 (83%) intubations were successful on the first attempt, 26 (9%) failures occurred, and one patient received a cricothyrotomy. The first-attempt success rate was 51 of 63 (81%, 95% confidence interval [CI] = 70% to 89%) for video laryngoscopy versus 182 of 217 (84%, 95% CI = 79% to 88%) for direct laryngoscopy (p = 0.59). Median time to successful intubation was 42 seconds (range, 13 to 350 seconds) for video laryngoscopy versus 30 seconds (range, 11 to 600 seconds) for direct laryngoscopy (p < 0.01).

Conclusions:  Rates of successful intubation on first attempt were not significantly different between video and direct laryngoscopy. However, intubation using video laryngoscopy required significantly more time to complete.

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