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Abstract 3: Comparison of First Pass and Overall Success Rates of Intubation Between Direct Laryngoscopy, Bougie-assisted Laryngoscopy, and Video Laryngoscopy
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2016 Critical Care Transport Medicine Conference Scientific Forum / Air Medical Journal 35 (2016) 205e207
Paramedic or Certified Critical Care Paramedic (FP-C/CCP-C) compared to 24% for Primary 911 programs and 43% for Primary interfacility programs. Additionally, Combined Programs respondents reported more required adult critical care initial training (73%) and annual training (80%) than Primary 911 programs (27% and 29% respectively). For Obstetrical training, the results showed a similar difference between program types. The composite score for program types revealed that Combined Programs were well within the industry standards for critical care (83%). However, Primary 911 programs were generally not within the industry critical care standards (37%). Primary Interfacility and Solely Interfacility programs were generally within the industry standards for critical care (51% and 55% respectively). Conclusions: The difference in some items between the program types is concerning, especially in some key items. The Composite Score results highlight the differences between program types as seen in the individual items. Respondents from a Primary 911 program that purports to be also offering critical care interfacility are not meeting half of the differences between an ALS level of care and Critical Care. Programs that are primarily interfacility based will tend to offer care at the Critical Care level, but just barely.
on the first attempt using video laryngoscopy. This was not a significant difference (p 0.077). Overall success between direct and video laryngoscopy was also insignificant (94.09% vs 98.48%, p ¼ 0.145). When comparing first pass and overall success rates between bougie-assisted and video laryngoscopy, no significant difference was found (first pass success 88.89% vs 90.91%, p ¼ 0.646; overall success 95.24% vs 98.48%, p ¼ 0.242). Conclusion: Incorporation of the gum elastic bougie to assist in endotracheal intubations offers a statistically significant improvement in first pass success rate over direct laryngoscopy. Video laryngoscopy shows a trend towards improved first pass success compared to direct and bougie-assisted laryngoscopy, but in this study has no statistical significance due to lack of power. Adjunctive airway devices should be considered first line in pre-hospital care for critically ill patients requiring advanced airway maneuvers.
THIRD PLACE Abstract 3: Comparison of First Pass and Overall Success Rates of Intubation Between Direct Laryngoscopy, Bougie-assisted Laryngoscopy, and Video Laryngoscopy
Objectives: The most appropriate location to attempt an advanced airway in the prehospital setting has been a topic of discussion for many years. The purpose of this study is to explore intubation success for air medical flight crews during transport settings versus stationary settings. Methods: The study is a retrospective observational review of all patients requiring intubation in the prehospital setting with a national air medical transport company. After completion of a flight, the crew completed an airway continuous quality improvement (CQI) form documenting multiple aspects of the intubation. Upon completion of the form, the data were collated and analyzed using confidence intervals on first pass success as the primary outcome measure. The incidence of oxygen desaturation events was also reported. An intubation attempt was defined by the insertion of a laryngoscope blade into the patient's mouth. Successful placement required confirmation by quantitative capnography. Desaturation was defined as either 1) a decrease in SpO2 to 93% or below or 2) a decrease in oxygen saturation by 10% form the initial Sp02 value. Stationary intubation settings were defined as any intubation attempt made where the patient was not in transport when the intubation attempt was being attempted. Results: Intubation was attempted in a total of 3,254 patients during the study period, with success on the first attempt documented in 2,947 of these (90.6%, 95% CI 87.5%- 93.6%). Intubation was eventually successful in a total of 3,186 patients (97.9%, 95% CI 97.6%- 98.3%). A total of 2,835 first attempts of these occurred in a stationary setting, of which 2,565 were successful (90.5%, 95% CI 87.2 %- 93.8 %). The initial intubation attempt was made during transport in a total of 418 patients, with 382 intubated successfully on the first attempt (91.1%, 95% CI 82.5 %- 99.8%). Oxygen desaturation occurred during 676 of initial intubation attempts in a stationary setting (23.2%, 95% CI 21.9%-24.7%) and during 131 of initial intubation attempts during transport (30.6%, 95% CI 26.4%-34.8%). Conclusion: We document high first attempt intubation success rates for patients undergoing attempts in either a stationary setting or during transport. The desaturation rate was slightly higher during transport. This data suggests competency in either setting, however there is a greater complication of desaturation while intubating during flight. This analysis is limited by selection bias toward performing airway management in a stationary setting in patients anticipated to have difficult airways. Future studies should explore various factors predicting success during transport versus a
Jason Burkett, DO; Elizabeth Beil, MD; David Schoenwetter, DO; Samuel Slimmer, MD. Geisinger Health System, Geisinger Medical Center and Geisinger Life Flight Objective: To examine whether or not the use of the gum elastic bougie and/or a video laryngoscopy device improves first pass and overall success rates of endotracheal intubation performed by prehospital aeromedical providers. Methods: First pass success was defined as the number of patients successfully intubated on the first attempt divided by the total number of patients intubated. Overall success was defined as the number of patient successfully intubated (on first pass or subsequent attempts) divided by the number of patients successfully intubated. For these two success rates a chi-square test was performed to compare the changes in success rates between direct laryngoscopy, bougie-assisted laryngoscopy, and video laryngoscopy. A logistic regression model was applied, with the following factors controlled: trauma versus medical pathology, airway difficulty (modified 3-3-2 exam), and gender. All tests were two sided and p-values <0.05 were considered significant. Analyses done using SAS v9.4 software (SAS Institute Inc., Cary, NC, USA.). Results: In this study 509 patients were analyzed. Comparing direct laryngoscopy to bougie-assisted laryngoscopy, 254 patients were intubated using the direct technique and 189 patients were intubated with the use of the gum elastic bougie. 208/254 (81.89%) of patients were intubated on the first attempt using the direct technique and 168/189 (88.89%) of patients were intubated on the first attempt using the gum elastic bougie. This represents a statistically significant increase with a p-value of 0.042. Overall, 239/ 254 (94.09%) of patients who underwent direct laryngoscopy and 180/189 (95.24%) of patients who underwent bougie-assisted laryngoscopy were intubated successfully. This was not a significant difference (p ¼ 0.599). Comparing direct laryngoscopy to video laryngoscopy, 254 patients were intubated using the direct technique and 66 patients were intubated using video laryngoscopy. 208/254 (81.89%) patients were intubated on the first attempt using the direct technique and 60/66 (90.91%) of patients were intubated
Abstract 1: Airway Intubation Stationary vs. Transport David J. Olvera, FP-C, NREMT-P; Daniel Davis, MD, FACEP; Allen C. Wolfe Jr., MSN, RN, CNS, CFRN, CCRN, CMTE; Charles F. Swearingen, BS, NRP, FP-C. Air Methods Corporation
2016 Critical Care Transport Medicine Conference Scientific Forum / Air Medical Journal 35 (2016) 205e207
Paramedic or Certified Critical Care Paramedic (FP-C/CCP-C) compared to 24% for Primary 911 programs and 43% for Primary interfacility programs. Additionally, Combined Programs respondents reported more required adult critical care initial training (73%) and annual training (80%) than Primary 911 programs (27% and 29% respectively). For Obstetrical training, the results showed a similar difference between program types. The composite score for program types revealed that Combined Programs were well within the industry standards for critical care (83%). However, Primary 911 programs were generally not within the industry critical care standards (37%). Primary Interfacility and Solely Interfacility programs were generally within the industry standards for critical care (51% and 55% respectively). Conclusions: The difference in some items between the program types is concerning, especially in some key items. The Composite Score results highlight the differences between program types as seen in the individual items. Respondents from a Primary 911 program that purports to be also offering critical care interfacility are not meeting half of the differences between an ALS level of care and Critical Care. Programs that are primarily interfacility based will tend to offer care at the Critical Care level, but just barely.
on the first attempt using video laryngoscopy. This was not a significant difference (p 0.077). Overall success between direct and video laryngoscopy was also insignificant (94.09% vs 98.48%, p ¼ 0.145). When comparing first pass and overall success rates between bougie-assisted and video laryngoscopy, no significant difference was found (first pass success 88.89% vs 90.91%, p ¼ 0.646; overall success 95.24% vs 98.48%, p ¼ 0.242). Conclusion: Incorporation of the gum elastic bougie to assist in endotracheal intubations offers a statistically significant improvement in first pass success rate over direct laryngoscopy. Video laryngoscopy shows a trend towards improved first pass success compared to direct and bougie-assisted laryngoscopy, but in this study has no statistical significance due to lack of power. Adjunctive airway devices should be considered first line in pre-hospital care for critically ill patients requiring advanced airway maneuvers.
THIRD PLACE Abstract 3: Comparison of First Pass and Overall Success Rates of Intubation Between Direct Laryngoscopy, Bougie-assisted Laryngoscopy, and Video Laryngoscopy
Objectives: The most appropriate location to attempt an advanced airway in the prehospital setting has been a topic of discussion for many years. The purpose of this study is to explore intubation success for air medical flight crews during transport settings versus stationary settings. Methods: The study is a retrospective observational review of all patients requiring intubation in the prehospital setting with a national air medical transport company. After completion of a flight, the crew completed an airway continuous quality improvement (CQI) form documenting multiple aspects of the intubation. Upon completion of the form, the data were collated and analyzed using confidence intervals on first pass success as the primary outcome measure. The incidence of oxygen desaturation events was also reported. An intubation attempt was defined by the insertion of a laryngoscope blade into the patient's mouth. Successful placement required confirmation by quantitative capnography. Desaturation was defined as either 1) a decrease in SpO2 to 93% or below or 2) a decrease in oxygen saturation by 10% form the initial Sp02 value. Stationary intubation settings were defined as any intubation attempt made where the patient was not in transport when the intubation attempt was being attempted. Results: Intubation was attempted in a total of 3,254 patients during the study period, with success on the first attempt documented in 2,947 of these (90.6%, 95% CI 87.5%- 93.6%). Intubation was eventually successful in a total of 3,186 patients (97.9%, 95% CI 97.6%- 98.3%). A total of 2,835 first attempts of these occurred in a stationary setting, of which 2,565 were successful (90.5%, 95% CI 87.2 %- 93.8 %). The initial intubation attempt was made during transport in a total of 418 patients, with 382 intubated successfully on the first attempt (91.1%, 95% CI 82.5 %- 99.8%). Oxygen desaturation occurred during 676 of initial intubation attempts in a stationary setting (23.2%, 95% CI 21.9%-24.7%) and during 131 of initial intubation attempts during transport (30.6%, 95% CI 26.4%-34.8%). Conclusion: We document high first attempt intubation success rates for patients undergoing attempts in either a stationary setting or during transport. The desaturation rate was slightly higher during transport. This data suggests competency in either setting, however there is a greater complication of desaturation while intubating during flight. This analysis is limited by selection bias toward performing airway management in a stationary setting in patients anticipated to have difficult airways. Future studies should explore various factors predicting success during transport versus a
Jason Burkett, DO; Elizabeth Beil, MD; David Schoenwetter, DO; Samuel Slimmer, MD. Geisinger Health System, Geisinger Medical Center and Geisinger Life Flight Objective: To examine whether or not the use of the gum elastic bougie and/or a video laryngoscopy device improves first pass and overall success rates of endotracheal intubation performed by prehospital aeromedical providers. Methods: First pass success was defined as the number of patients successfully intubated on the first attempt divided by the total number of patients intubated. Overall success was defined as the number of patient successfully intubated (on first pass or subsequent attempts) divided by the number of patients successfully intubated. For these two success rates a chi-square test was performed to compare the changes in success rates between direct laryngoscopy, bougie-assisted laryngoscopy, and video laryngoscopy. A logistic regression model was applied, with the following factors controlled: trauma versus medical pathology, airway difficulty (modified 3-3-2 exam), and gender. All tests were two sided and p-values <0.05 were considered significant. Analyses done using SAS v9.4 software (SAS Institute Inc., Cary, NC, USA.). Results: In this study 509 patients were analyzed. Comparing direct laryngoscopy to bougie-assisted laryngoscopy, 254 patients were intubated using the direct technique and 189 patients were intubated with the use of the gum elastic bougie. 208/254 (81.89%) of patients were intubated on the first attempt using the direct technique and 168/189 (88.89%) of patients were intubated on the first attempt using the gum elastic bougie. This represents a statistically significant increase with a p-value of 0.042. Overall, 239/ 254 (94.09%) of patients who underwent direct laryngoscopy and 180/189 (95.24%) of patients who underwent bougie-assisted laryngoscopy were intubated successfully. This was not a significant difference (p ¼ 0.599). Comparing direct laryngoscopy to video laryngoscopy, 254 patients were intubated using the direct technique and 66 patients were intubated using video laryngoscopy. 208/254 (81.89%) patients were intubated on the first attempt using the direct technique and 60/66 (90.91%) of patients were intubated
Abstract 1: Airway Intubation Stationary vs. Transport David J. Olvera, FP-C, NREMT-P; Daniel Davis, MD, FACEP; Allen C. Wolfe Jr., MSN, RN, CNS, CFRN, CCRN, CMTE; Charles F. Swearingen, BS, NRP, FP-C. Air Methods Corporation