Video Laryngoscopy

With the advanced airway debate comes a need for solutions. Obviously increased training and QI/QA are at the top of the list. Another option is the Glidescope. This device is just one of a few video laryngoscopy devices that has shown phenomenal results. They are an expensive option, but probably cheaper than malpractice payouts. There is a ton of research out there regarding these devices. I have seen them used in the ER with great success, and I believe our helicopter has acquired one. Check out the video at the bottom.

Keep in mind that I am not the biggest advocate of prehospital intubation. Not until we improve our success rates and recognition of dislodged tubes. I believe laryngeal tubes and BVMs are the safer alternative as of yet. With that in mind, endotracheal intubation is the best way to secure an airway when performed adequately.

Pubmed [1]
BACKGROUND AND OBJECTIVE: We investigated whether the use of two different video laryngoscopes [direct-coupled interface (DCI) video laryngoscope and GlideScope] may improve laryngoscopic view and intubation success compared with the conventional direct Macintosh laryngoscope (direct laryngoscopy) in patients with a predicted difficult airway. METHODS: One hundred and twenty adult patients undergoing elective minor surgery requiring general anaesthesia and endotracheal intubation presenting with at least one predictor for a difficult airway were enrolled after Institutional Review Board approval and written informed consent was obtained. Repeated laryngoscopy was performed using direct laryngoscope, DCI laryngoscope and GlideScope in a randomized sequence before patients were intubated. RESULTS: Both video laryngoscopes showed significantly better laryngoscopic view (according to Cormack and Lehane classification as modified by Yentis and Lee = C&L) than direct laryngoscope. Laryngoscopic view C&L >or= III was measured in 30% of patients when using direct laryngoscopy, and in only 11% when using the DCI laryngoscope (P <>or= III: 1.6%) than both direct (P <>or= III) could be achieved significantly more often with the GlideScope (94.4%) than with the DCI laryngoscope (63.8%) Laryngoscopy time did not differ between instruments [median (range): direct laryngoscope, 13 (5-33) s; DCI laryngoscope, 14 (6-40) s; GlideScope, 13 (5-34) s]. In contrast, tracheal intubation needed significantly more time with both video laryngoscopes [DCI laryngoscope, 27 (17-94) s, and GlideScope, 33 (18-68) s, P less than 0.01] than with the direct laryngoscope [22.5 (12-49) s]. Intubation failed in four cases (10%) using the direct laryngoscope and in one case (2.5%) each using the DCI laryngoscope and the GlideScope. CONCLUSION: We conclude that the video laryngoscope and GlideScope in particular may be useful instruments in the management of the predicted difficult airway.


Shaggy said...

This is an expensive item and I could not see it being supplied on a fleet of trucks.

The savings from steering clear of a lawsuit should not be the driving force. Most EMS providers seem to be pushed by that force. The force that should drive us is the quest to provide the best care for our patients. This is a device that will provide better intubation results, therefore, I believe it is better patient care.
Yes, the cost savings in forgoing a legal case is important, but with the cost of this device though, many agencies will take their chances and protect themselves in outher ways.

Adam Thompson, EMT-P said...

Just a suggestion. We aren't going to see this on large fleets. The next suggestion I have is one we are field testing. The S.A.L.T. device.

Shaggy said...

I was wondering about bringing up the S.A.L.T device. I read about it lately but still have yet to actually hold it in my hand and practice with it or even see a live demo of it. I bet I will see it at the EMS conferences I attend this year. I can't wait until you discuss it.

CLD said...

It is interesting to see where the technology in new Laryngoscopes is headed. The capabilities of these products are amazing, however it seems that there price has become an issue. In time, we will see more products come along and the price lower as technology advances.