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John C Sakles - One of the best experts on this subject based on the ideXlab platform.
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video laryngoscopy improves odds of first attempt success at Intubation in the intensive care unit a propensity matched analysis
Annals of the American Thoracic Society, 2016Co-Authors: Cameron Hypes, Uwe Stolz, John C Sakles, Raj Joshi, Bhupinder Natt, Josh Malo, John W Bloom, Jarrod MosierAbstract:Rationale: Urgent tracheal Intubation is performed frequently in intensive care units and incurs higher risk than when Intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal Intubation on the first attempt; however, existing comparative data on outcomes are limited.Objectives: To compare first-attempt success and complication rates during Intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit.Methods: We prospectively collected and analyzed data from a continuous quality improvement database of all Intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding.Measurements and Main Results: A total of 809 Intubations took place over the study period. Of these, 673 (83.2%) were performed using video la...
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video laryngoscopy improves Intubation success and reduces esophageal Intubations compared to direct laryngoscopy in the medical intensive care unit
Critical Care, 2013Co-Authors: Jarrod Mosier, John W Bloom, Sage P Whitmore, Linda Snyder, Lisa Graham, Gordon E Carr, John C SaklesAbstract:Introduction Tracheal Intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make Intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU Intubations.
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A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department
Annals of Emergency Medicine, 2012Co-Authors: John C Sakles, Jarrod Mosier, Stephen Chiu, Mari Cosentino, Leah KalinAbstract:Study objective We determine the proportion of successful Intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) Intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each Intubation, the operator completed a standardized data form evaluating multiple aspects of the Intubation, including patient demographics, indication for Intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal Intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 Intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful Intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful Intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When the C-MAC was used as a video laryngoscope, a Cormack-Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%). The C-MAC was associated with immediately recognized esophageal Intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal Intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%). Conclusion When used for emergency Intubations in the ED, the C-MAC was associated with a greater proportion of successful Intubations and a greater proportion of Cormack-Lehane grade I or II views compared with a direct laryngoscope.
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airway management in the emergency department a one year study of 610 tracheal Intubations
Annals of Emergency Medicine, 1998Co-Authors: John C Sakles, Erik G Laurin, Aaron A Rantapaa, Edward A PanacekAbstract:Abstract Study objective: To describe the methods, success rates, and immediate complications of tracheal Intubations performed in the emergency department of an urban teaching hospital. Methods: This was an observational, consecutive series undertaken in an urban university hospital with an emergency medicine residency training program and an annual ED census of 60,000 patients. The study population included all patients for whom Intubation was attempted in the ED during a 1-year period (July 1, 1995 through June 30, 1996). At the time of each Intubation, the intubator filled out an Intubation data collection form. If an Intubation was performed in the ED but no form was filled out, the data were obtained from the medical record. Results: A total of 610 patients required airway control in the ED; 569 (93%) were intubated by emergency medicine residents or attending physicians. Rapid-sequence Intubation (RSI) was used in 515 (84%). A total of 603 patients (98.9%) were successfully intubated; 7 patients could not be intubated and underwent cricothyrotomy. In 33 patients, inadvertent placement into the esophagus occurred; all such situations were rapidly recognized and corrected. Eight (24%) of the 33 esophageal Intubations resulted in a reported immediate complication. Overall, 49 patients (8.0%; 95% confidence interval [CI], 6% to 11%) experienced a total of 57 immediate complications (9.3%; 95% CI, 7% to 12%). Three patients sustained a cardiac arrest after Intubation; two of these patients had agonal rhythms before Intubation, and one probably had a succinylcholine-induced hyperkalemic cardiac arrest. Conclusion: At this institution, the majority of ED Intubations were performed by emergency physicians and RSI was the most common method used. Emergency physicians intubated critically ill and injured ED patients with a very high success rate and a low rate of serious complications. [Sakles JC, Laurin EG, Rantapaa AA, Panacek EA: Airway management in the emergency department: A one-year study of 610 tracheal Intubations. Ann Emerg Med March 1998;31:325-332.]
T M Cook - One of the best experts on this subject based on the ideXlab platform.
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videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal Intubation a cochrane systematic review
BJA: British Journal of Anaesthesia, 2017Co-Authors: Sharon R Lewis, Andrew R Butler, J Parker, T M Cook, Oliver J Schofieldrobinson, Andrew F SmithAbstract:Difficulties with tracheal Intubation commonly arise and impact patient safety. This systematic review evaluates whether videolaryngoscopes reduce Intubation failure and complications compared with direct laryngoscopy in adults. We searched CENTRAL, MEDLINE, Embase and clinicaltrials.gov up to February 2015, and conducted forward and backward citation tracking. We included randomized controlled trials that compared adult patients undergoing laryngoscopy with videolaryngoscopy or Macintosh laryngoscopy. We did not primarily intend to compare individual videolaryngoscopes. Sixty-four studies (7044 participants) were included. Moderate quality evidence showed that videolaryngoscopy reduced failed Intubations (Odds Ratio (OR) 0.35, 95% Confidence Interval (CI) 0.19-0.65) including in participants with anticipated difficult airways (OR 0.28, 95% CI 0.15-0.55). There was no evidence of reduction in hypoxia or mortality, but few studies reported these outcomes. Videolaryngoscopes reduced laryngeal/airway trauma (OR 0.68, 95% CI 0.48-0.96) and hoarseness (OR 0.57, 95% CI 0.36-0.88). Videolaryngoscopy increased easy laryngeal views (OR 6.77, 95% CI 4.17-10.98) and reduced difficult views (OR 0.18, 95% CI 0.13-0.27) and Intubation difficulty, typically using an 'Intubation difficulty score' (OR 7.13, 95% CI 3.12-16.31). Failed Intubations were reduced with experienced operators (OR 0.32, 95% CI 0.13-0.75) but not with inexperienced users. We identified no difference in number of first attempts and incidence of sore throat. Heterogeneity around time for Intubation data prevented meta-analysis. We found evidence of differential performance between different videolaryngoscope designs. Lack of data prevented analysis of impact of obesity or clinical location on failed Intubation rates. Videolaryngoscopes may reduce the number of failed Intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a videolaryngoscope reduces the number of Intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a videolaryngoscope affects time required for Intubation.
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evaluation of a single use intubating videoscope ambu ascope in three airway training manikins for oral Intubation nasal Intubation and Intubation via three supraglottic airway devices
Anaesthesia, 2011Co-Authors: S Scutt, T M Cook, N Clark, C Smith, T Christmas, L Coppel, K CrewdsonAbstract:We compared the Ambu aScope ™ with a conventional fibrescope in two simulated settings. First, 22 volunteers performed paired oral and nasal fibreoptic Intubations in three different manikins: the Laerdal Airway Trainer, Bill 1 and the Airsim (a total of 264 Intubations). Second, 21 volunteers intubated the Airway Trainer manikin via three supraglottic airways: classic and intubating laryngeal mask airways and i-gel (a total of 66 Intubations). Performance of the aScope was good with few failures and infrequent problems. In the first study, choice of fibrescope had an impact on the number of user-reported problems (p = 0.004), and user-assessed ratings of ease of endoscopy (p < 0.001) and overall usefulness (p < 0.001), but not on time to intubate (p = 0.19), or ease of railroading (p = 0.72). The manikin chosen and route of endoscopy had more consistent effects on performance: best performance was via the nasal route in the Airway Trainer manikin. In the second study, the choice of fibrescope did not significantly affect any performance outcome (p = 0.3), but there was a significant difference in the speed of Intubation between the devices (p = 0.02) with the i-gel the fastest Intubation conduit (mean (SD) Intubation time i-gel 18.5 (6.8) s, intubating laryngeal mask airway = 24.1 (11.2) s, classic laryngeal mask airway = 31.4 (32.5) s, p = 0.02). We conclude that the aScope performs well in simulated fibreoptic Intubation and (if adapted for untimed use) would be a useful training tool for both simulated fibreoptic Intubation and conduit-assisted Intubation. The choice of manikin and conduit are also important in the success of such training. This manikin study does not predict performance in humans and a clinical study is required.
Jarrod Mosier - One of the best experts on this subject based on the ideXlab platform.
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video laryngoscopy improves odds of first attempt success at Intubation in the intensive care unit a propensity matched analysis
Annals of the American Thoracic Society, 2016Co-Authors: Cameron Hypes, Uwe Stolz, John C Sakles, Raj Joshi, Bhupinder Natt, Josh Malo, John W Bloom, Jarrod MosierAbstract:Rationale: Urgent tracheal Intubation is performed frequently in intensive care units and incurs higher risk than when Intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal Intubation on the first attempt; however, existing comparative data on outcomes are limited.Objectives: To compare first-attempt success and complication rates during Intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit.Methods: We prospectively collected and analyzed data from a continuous quality improvement database of all Intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding.Measurements and Main Results: A total of 809 Intubations took place over the study period. Of these, 673 (83.2%) were performed using video la...
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video laryngoscopy improves Intubation success and reduces esophageal Intubations compared to direct laryngoscopy in the medical intensive care unit
Critical Care, 2013Co-Authors: Jarrod Mosier, John W Bloom, Sage P Whitmore, Linda Snyder, Lisa Graham, Gordon E Carr, John C SaklesAbstract:Introduction Tracheal Intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make Intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU Intubations.
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A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department
Annals of Emergency Medicine, 2012Co-Authors: John C Sakles, Jarrod Mosier, Stephen Chiu, Mari Cosentino, Leah KalinAbstract:Study objective We determine the proportion of successful Intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) Intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each Intubation, the operator completed a standardized data form evaluating multiple aspects of the Intubation, including patient demographics, indication for Intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal Intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 Intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful Intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful Intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When the C-MAC was used as a video laryngoscope, a Cormack-Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%). The C-MAC was associated with immediately recognized esophageal Intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal Intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%). Conclusion When used for emergency Intubations in the ED, the C-MAC was associated with a greater proportion of successful Intubations and a greater proportion of Cormack-Lehane grade I or II views compared with a direct laryngoscope.
Calvin A. Brown - One of the best experts on this subject based on the ideXlab platform.
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video laryngoscopy compared to augmented direct laryngoscopy in adult emergency department tracheal Intubations a national emergency airway registry near study
Academic Emergency Medicine, 2020Co-Authors: Andrea Fantegrossi, Calvin A. Brown, Michael D April, Ron M Walls, Amy H Kaji, Jestin N Carlson, Robert W KilgoAbstract:Objective The objective was to compare first-attempt Intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning, and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department (ED) Intubations. Methods This study was a secondary analysis of a multicenter prospective observational database of ED Intubations from the National Emergency Airway Registry (NEAR). We compared all VL procedures to seven exploratory permutations of A-DL using multivariable regression models. We further stratified by blade shape into hyperangulated VL (HA-VL) and standard-geometry VL (SG-VL). We report differences in first-attempt Intubation success and peri-Intubation adverse events with cluster-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). We report univariate comparisons in patient characteristics, difficult airway attributes, and Intubation methods using descriptive statistics and OR with 95% CI. Results We analyzed 11,714 Intubations performed from January 1, 2016, through December 31, 2017. Of these encounters, 6,938 underwent orotracheal Intubation with either A-DL or unaided VL on first attempt. A-DL was used first in 3,936 (56.7%, 95% CI = 46.9 to 66.5) versus unaided VL in 3,002 (43.3%, 95% CI = 33.5 to 53.1). Of the A-DL first Intubations 1,787 (45.4%) employed ramped positioning alone, 1,472 (37.4%) had external laryngeal manipulation (ELM), and 365 (9.3%) used a bougie. Rapid sequence Intubation (RSI) was the most common method used in 5,602 (80.8%, 95% CI = 77.0 to 84.5) cases. First-attempt success was significantly higher with all VL (90.9%, 95% CI = 88.7 to 93.1) versus all A-DL (81.1%, 95% CI = 78.7 to 83.5) despite the VL group having more patients with reduced mouth opening, neck immobility, and an initial impression of airway difficult. Multivariable regression analyses controlling for indication, method, operator specialty and year of training, center clustering, and all registry-recorded difficult airway predictors revealed first-attempt success was higher with all unaided VL compared with any A-DL (adjusted OR [AOR] = 2.8, 95% CI = 2.4 to 3.3), DL with bougie (AOR = 2.7, 95% CI = 2.1 to 3.5), DL with ELM (AOR = 1.8, 95% CI = 1.5 to 2.2), DL with ramped positioning (AOR = 2.8, 95% CI = 2.3 to 3.3), or DL with ELM plus bougie (AOR = 2.8, 95% CI = 2.3 to 3.3). Subgroup analyses of HA-VL and SG-VL compared with any A-DL yielded similar results (AOR = 3.2, 95% CI = 2.6 to 3.0; and AOR = 2.4, 95% CI = 1.9 to 3.0, respectively). The propensity score-adjusted odds for first-attempt success with VL was also 2.8 (95% CI = 2.4 to 3.3). Fewer esophageal Intubations were observed in the VL cohort (0.4% vs. 1.3%, AOR = 0.2, 95% CI = 0.1 to 0.5). Conclusions Video laryngoscopy used without any augmenting maneuver, device, or technique results in higher first-attempt success than does DL that is augmented by use of a bougie, ELM, ramping, or combinations thereof.
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emergency department Intubation success with succinylcholine versus rocuronium a national emergency airway registry study
Annals of Emergency Medicine, 2018Co-Authors: Michael D April, Allyson A Arana, Steven G Schauer, Andrea Fantegrossi, Jessie Renee D Fernandez, Shane M Summers, Mark A Antonacci, Daniel J. Pallin, Joseph K Maddry, Calvin A. BrownAbstract:Study objective Although both succinylcholine and rocuronium are used to facilitate emergency department (ED) rapid sequence Intubation, the difference in Intubation success rate between them is unknown. We compare first-pass Intubation success between ED rapid sequence Intubation facilitated by succinylcholine versus rocuronium. Methods We analyzed prospectively collected data from the National Emergency Airway Registry, a multicenter registry collecting data on all Intubations performed in 22 EDs. We included Intubations of patients older than 14 years who received succinylcholine or rocuronium during 2016. We compared the first-pass Intubation success between patients receiving succinylcholine and those receiving rocuronium. We also compared the incidence of adverse events (cardiac arrest, dental trauma, direct airway injury, dysrhythmias, epistaxis, esophageal Intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus Intubation, malignant hyperthermia, medication error, pharyngeal laceration, pneumothorax, endotracheal tube cuff failure, and vomiting). We conducted subgroup analyses stratified by paralytic weight-based dose. Results There were 2,275 rapid sequence Intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo Intubation with video laryngoscopy and by more experienced providers. First-pass Intubation success rate was 87.0% with succinylcholine versus 87.5% with rocuronium (adjusted odds ratio 0.9; 95% confidence interval 0.6 to 1.3). The incidence of any adverse event was also comparable between these agents: 14.7% for succinylcholine versus 14.8% for rocuronium (adjusted odds ratio 1.1; 95% confidence interval 0.9 to 1.3). We observed similar results when they were stratified by paralytic weight-based dose. Conclusion In this large observational series, we did not detect an association between paralytic choice and first-pass rapid sequence Intubation success or peri-Intubation adverse events.
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techniques success and adverse events of emergency department adult Intubations
Annals of Emergency Medicine, 2015Co-Authors: Calvin A. Brown, Daniel J. Pallin, Aaron E Bair, Ron M WallsAbstract:Study objective We describe the operators, techniques, success, and adverse event rates of adult emergency department (ED) Intubation through multicenter prospective surveillance. Methods Eighteen EDs in the United States, Canada, and Australia recorded Intubation data onto a Web-based data collection tool, with a greater than or equal to 90% reporting compliance requirement. We report proportions with binomial 95% confidence intervals (CIs) and regression, with year as the dependent variable, to model change over time. Results Of 18 participating centers, 5 were excluded for failing to meet compliance standards. From the remaining 13 centers, we report data on 17,583 emergency Intubations of patients aged 15 years or older from 2002 to 2012. Indications were medical in 65% of patients and trauma in 31%. Rapid sequence Intubation was the first method attempted in 85% of encounters. Emergency physicians managed 95% of Intubations and most (79%) were physician trainees. Direct laryngoscopy was used in 84% of first attempts. Video laryngoscopy use increased from less than 1% in the first 3 years to 27% in the last 3 years (risk difference 27%; 95% CI 25% to 28%; mean odds ratio increase per year [ie, slope] 1.7; 95% CI 1.6 to 1.8). Etomidate was used in 91% and succinylcholine in 75% of rapid sequence Intubations. Among rapid sequence Intubations, rocuronium use increased from 8.2% in the first 3 years to 42% in the last 3 years (mean odds ratio increase per year 1.3; 95% CI 1.3 to 1.3). The first-attempt Intubation success rate was 83% (95% CI 83% to 84%) and was higher in the last 3 years than in the first 3 (86% versus 80%; risk difference 6.2%; 95% CI 4.2% to 7.8%). The airway was successfully secured in 99.4% of encounters (95% CI 99.3% to 99.6%). Conclusion In the EDs we studied, emergency Intubation has a high and increasing success rate. Both drug and device selection evolved significantly during the study period.
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association between repeated Intubation attempts and adverse events in emergency departments an analysis of a multicenter prospective observational study
Annals of Emergency Medicine, 2012Co-Authors: Calvin A. Brown, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa, Takuyo Chiba, Kazuaki Shigemitsu, David F M BrownAbstract:Study objective Although repeated Intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED Intubation attempts are associated with an increased risk of adverse events. Methods We conducted an analysis of a multicenter prospective registry of 11 Japanese EDs between April 2010 and September 2011. All patients undergoing emergency Intubation with direct laryngoscopy as the initial device were included. The primary exposure was multiple Intubation attempts, defined as Intubation efforts requiring greater than or equal to 3 laryngoscopies. The primary outcome measure was the occurrence of Intubation-related adverse events in the ED, including cardiac arrest, dysrhythmia, hypotension, hypoxemia, unrecognized esophageal Intubation, regurgitation, airway trauma, dental or lip trauma, and mainstem bronchus Intubation. Results Of 2,616 patients, 280 (11%) required greater than or equal to 3 Intubation attempts. Compared with patients requiring 2 or fewer Intubation attempts, patients undergoing multiple attempts exhibited a higher adverse event rate (35% versus 9%). After adjusting for age, sex, principal indication, method, medication, and operator characteristics, Intubations requiring multiple attempts were associated with an increased odds of adverse events (odds ratio 4.5; 95% confidence interval 3.4 to 6.1). Conclusion In this large Japanese multicenter study of ED patients undergoing Intubation, we found that multiple Intubation attempts were independently associated with increased adverse events.
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emergency airway management in japan interim analysis of a multi center prospective observational study
Resuscitation, 2012Co-Authors: Ron M Walls, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa, Takuyo Chiba, David F M Brown, Calvin A. BrownAbstract:Abstract Objectives Emergency medicine is increasingly recognized as a medical specialty in Japan. However, comprehensive studies evaluating emergency airway management practice are lacking. We describe emergency department (ED) airway management using a large multi-center registry. Methods We formed the Japanese Emergency Airway Network, a consortium of 10 academic and community medical centers in Japan, and prospectively collected data on ED Intubations from April 2010 to February 2011. All patients undergoing emergency Intubation were eligible for inclusion. Data were entered in real time by the intubator using a standardized data form. Variables included patient's age, sex, weight, indication for Intubation, methods of Intubation, drugs, level of training and specialty of the intubator, number of attempts, success or failure, and adverse events. We present descriptive data as proportions with 95% confidence intervals. Results We recorded 1486 Intubations (compliance rate 99%). Intubation was ultimately successful in 99.7%. The initial method of Intubation varied substantially among the hospitals, including rapid sequence Intubation (0–79%), sedation without paralysis (4–88%), paralysis without sedation (0–18%), and oral without medication (12–67%), in non-cardiac arrest encounters. Success rates in first and ≤3 attempts ranged from 40 to 83% and from 74 to 100%, respectively. The overall adverse event rate was 11%, without significant difference by the method used. Conclusions In this multi-center study characterizing ED airway management across Japan, we observed a high overall success rate but a high degree of variation among hospitals in the methods of Intubation and success rates.
Mohan Pammi - One of the best experts on this subject based on the ideXlab platform.
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videolaryngoscopy versus direct laryngoscopy for tracheal Intubation in neonates
Cochrane Database of Systematic Reviews, 2015Co-Authors: Krithika Lingappan, Jennifer Arnold, Caraciolo J Fernandes, Mohan PammiAbstract:Background Establishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal unit. Videolaryngoscopy has the potential to facilitate successful endotracheal Intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and Intubation success in neonates. Objectives To determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required for endotracheal Intubation and increasing the success rate at first Intubation in neonates. Search methods We used the search strategy of Cochrane Neonatal. In May 2017, we searched for randomized controlled trials (RCT) evaluating videolaryngoscopy for neonatal endotracheal Intubation in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, abstracts of the Pediatric Academic Societies, websites for registered trials at www.clinicaltrials.gov and www.controlled-trials.com, and reference lists of relevant studies. Selection criteria RCTs or quasi-RCTs in neonates evaluating videolaryngoscopy for endotracheal Intubation compared with direct laryngoscopy. Data collection and analysis Review authors performed data collection and analysis as recommended by Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion. We used the GRADE approach to assess the quality of evidence. Main results The search yielded 7057 references of which we identified three RCTs for inclusion, four ongoing trials and one study awaiting classification. All three included RCTs compared videolaryngoscopy with direct laryngoscopy during Intubation attempts by trainees. Time to Intubation was similar between videolaryngoscopy and direct laryngoscopy (mean difference (MD) -0.62, 95% confidence interval (CI) -6.50 to 5.26; 2 studies; 311 Intubations) (very low quality evidence). Videolaryngoscopy did not decrease the number of Intubation attempts (MD -0.05, 95% CI -0.18 to 0.07; 2 studies; 427 Intubations) (very low quality evidence). Moderate quality evidence suggested that videolaryngoscopy increased the success of Intubation at first attempt (typical risk ratio (RR) 1.44, 95% CI 1.20 to 1.73; typical risk difference (RD) 0.19, 95% CI 0.10 to 0.28; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 4 to 10; 3 studies; 467 Intubation attempts). Desaturation episodes during Intubation attempts were similar between videolaryngoscopy and direct laryngoscopy (MD -0.76, 95% CI -5.74 to 4.23; 2 studies; 359 Intubations) (low quality evidence). There was no difference in the incidence of airway trauma due to Intubation attempts (RR 0.10, 95% CI 0.01 to 1.80; RD -0.04, 95% CI -0.09 to -0.00; 1 study; 213 Intubations) (low quality evidence). There were no data available on other adverse effects of videolaryngoscopy. Authors' conclusions Moderate to very low quality evidence suggests that videolaryngoscopy increases the success of Intubation in the first attempt but does not decrease the time to Intubation or the number of attempts for Intubation. However, these studies were conducted with trainees performing the Intubations and these results highlight the potential usefulness of the videolaryngoscopy as a teaching tool. Well-designed, adequately powered RCTs are necessary to confirm efficacy and address safety and cost-effectiveness of videolaryngoscopy for endotracheal Intubation in neonates by trainees and those proficient in direct laryngoscopy.
