Intubation Success after Introduction of a Quality Assurance Program Using Video Laryngoscopy

Louka, Amir; Stevenson, Christopher S.; Jones, Gregory; Ferguson, Jeffrey D.

doi:10.1016/j.amj.2018.05.001

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…In contrast, the authors of Huebinger 2021, the largest study included in this analysis, did not specify the type(s) of VL devices utilized in their large retrospective analysis. 16 Nonetheless, the current moderator analysis comparing three studies using standard geometry (C-MAC) video laryngoscopes and two studies using hyperangulated (King Vision) video laryngoscopes 15,[17][18][19][20] showed no difference in the first-pass success rate (Table 3), although this could be due to low power. Because this link is unclear, further studies are needed to elucidate whether certain devices are better suited for the prehospital setting.…”

Section: Discussionmentioning

confidence: 81%

“…The number of attempts for VL was not significantly less than for DL until 2018, with the publication of Louka, et al, according to the cumulative analysis (Figure 5B). 17 From the sensitivity analysis for the number of attempts (Figure 5C), the difference in means ranged from a very small difference (-0.075) to a larger difference in mean (-0.707). This suggested that effect size was affected by the 2015 Jarvis, et al study.…”

Section: Secondary Outcome 2: Number Of Attemptsmentioning

confidence: 99%

“…Two were randomized control trials (2013 Guyette, 2017 Ducharme), one was a prospective study (2020 Garcia-Pintos), and four were retrospective studies (2015 Jarvis, 2018 Louka, 2021 Huebinger, 2021 Lenz). [14][15][16][17][18][19][20] Three studies enrolled fewer than 100 patients (2017 Ducharme, 2018 Louka, 2020 Garcia-Pintos), while the 2021 Huebinger study involved a large population (22,132 patients). [15][16][17]20 In all the studies, a total of 6,674 patients underwent intubation via VL and 17,279 patients underwent DL (Table 1).…”

Section: Study Descriptionmentioning

confidence: 99%

“…[14][15][16][17][18][19][20] Three studies enrolled fewer than 100 patients (2017 Ducharme, 2018 Louka, 2020 Garcia-Pintos), while the 2021 Huebinger study involved a large population (22,132 patients). [15][16][17]20 In all the studies, a total of 6,674 patients underwent intubation via VL and 17,279 patients underwent DL (Table 1). Fourteen of 21 studies reported the outcomes of interest but were excluded because they used cadaver 21 or manikin conduits and not living adult patients.…”

Section: Study Descriptionmentioning

confidence: 99%

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Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

Pourmand

Terrebonne

Gerber

et al. 2022

Prehosp. Disaster med.

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Introduction: Placing an endotracheal tube is a life-saving measure. Direct laryngoscopy (DL) is traditionally the default method. Video laryngoscopy (VL) has been shown to improve efficiency, but there is insufficient evidence comparing VL versus DL in the prehospital settings. This study, comprising a systematic review and random-effects meta-analysis, assesses current literature for the efficacy of VL in prehospital settings. Methods: PubMed and Scopus databases were searched from their beginnings through March 1, 2022 for eligible studies. Outcomes were the ﬁrst successful intubation, overall success rate, and number of total DL versus VL attempts in real-life clinical situations. Cochrane’s Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess heterogeneity. Results: The search yielded seven studies involving 23,953 patients, 6,674 (28%) of whom underwent intubation via VL. Compared to DL, VL was associated with a statistically higher risk ratio for first-pass success (Risk Ratio [RR] = 1.116; 95% CI, 1.005-1.239; P = .041; I2 = 87%). The I2 value for the subgroup of prospective studies was 0% compared to 89% for retrospective studies. In addition, VL was associated with higher likelihood of overall success rate (RR = 1.097; 95% CI, 1.01-1.18; P = .021; I2 = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; P = .008). Conclusion: The meta-analysis suggested that VL was associated with higher likelihood of achieving first-pass success, greater overall success rate, and lower number of intubation attempts for adults in the prehospital settings. This study had high heterogeneity, likely presenced by the inclusion of retrospective observational studies. Further studies with more rigorous methodology are needed to confirm these results.

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Section: Discussionmentioning

confidence: 81%

Section: Secondary Outcome 2: Number Of Attemptsmentioning

confidence: 99%

Section: Study Descriptionmentioning

confidence: 99%

Section: Study Descriptionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

Pourmand

Terrebonne

Gerber

et al. 2022

Prehosp. Disaster med.

View full text Add to dashboard Cite

show abstract

“…Once the decision for prehospital ETI has been made the procedure needs to be undertaken to a high standard if it is to be beneficial [ 9 ]. The quality of ETI is difficult to measure [ 10 ], particularly if facilitated by sedative drugs (drug facilitated intubation—DFI) or through a combination of sedative drugs and a paralytic drug (rapid sequence intubation—RSI) [ 11 ]. Common variables reported as proxy-measures for the quality of ETI during prehospital DFI or RSI are the first pass success (FPS) rates, the number of intubations attempts required, overall failure rates of intubation (ie.…”

Section: Introductionmentioning

confidence: 99%

The effect of a multi-faceted quality improvement program on paramedic intubation success in the critical care transport environment: a before-and-after study

Vopelius-Feldt

Peddle

Lockwood

et al. 2023

Scand J Trauma Resusc Emerg Med

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Introduction Endotracheal intubation (ETI) is an infrequent but key component of prehospital and retrieval medicine. Common measures of quality of ETI are the first pass success rates (FPS) and ETI on the first attempt without occurrence of hypoxia or hypotension (DASH-1A). We present the results of a multi-faceted quality improvement program (QIP) on paramedic FPS and DASH-1A rates in a large regional critical care transport organization. Methods We conducted a retrospective database analysis, comparing FPS and DASH-1A rates before and after implementation of the QIP. We included all patients undergoing advanced airway management with a first strategy of ETI during the time period from January 2016 to December 2021. Results 484 patients met the inclusion criteria during the study period. Overall, the first pass intubation success (FPS) rate was 72% (350/484). There was an increase in FPS from the pre-intervention period (60%, 86/144) to the post-intervention period (86%, 148/173), p < 0.001. DASH-1A success rates improved from 45% (55/122) during the pre-intervention period to 55% (84/153) but this difference did not meet pre-defined statistical significance (p = 0.1). On univariate analysis, factors associated with improved FPS rates were the use of video-laryngoscope (VL), neuromuscular blockage, and intubation inside a healthcare facility. Conclusions A multi-faceted advanced airway management QIP resulted in increased FPS intubation rates and a non-significant improvement in DASH-1A rates. A combination of modern equipment, targeted training, standardization and ongoing clinical governance is required to achieve and maintain safe intubation by paramedics in the prehospital and retrieval environment.

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Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review

Dean

Kerrey

2022

JACEP Open

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Objective Published studies of video laryngoscopes are often limited by the lack of a clear definition of video laryngoscopy (VL). We performed a systematic review to determine how often published studies of VL report on video screen visualization. Methods We searched PubMed, EMBASE and Scopus for interventional and observational studies in which a video laryngoscope equipped with a standard geometry blade was used for tracheal intubation. We excluded simulation based studies. Our primary outcome was data on video laryngoscope screen visualization. Secondary outcomes were explicit methodology for screen visualization. Results We screened 4838 unique studies and included 207 (120 interventional and 87 observational). Only 21 studies (10% of 207) included any data on video screen visualization by the proceduralist, 19 in a yes/no fashion only (ie, screened viewed or not) and 2 with detail beyond whether the screen was viewed or not. In 11 more studies, visualization patterns could be inferred based on screen availability and in 16 more studies, the methods section stated how screen visualization was expected to be performed without reporting data collection on how the proceduralist interacted with the video screen. Risk of bias was high in the majority of included studies. Conclusions Published studies of VL, including many clinical trials, rarely include data on video screen visualization. Given the nuances of using a video laryngoscope, this is a critical deficiency, which largely prevents us from knowing the treatment effect of using a video laryngoscope in clinical practice. Future studies of VL must address this deficiency.

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Intubation Success after Introduction of a Quality Assurance Program Using Video Laryngoscopy

Cited by 10 publications

References 10 publications

Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

The effect of a multi-faceted quality improvement program on paramedic intubation success in the critical care transport environment: a before-and-after study

Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review

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