INTRODUCTION: Intubation success by paramedics has historically been variable. The lack of first-pass success (FPS) has been associated with increased adverse events. Various video laryngoscope (VL) devices have been investigated to improve success among paramedics. Conflicting research exists on VL vs. direct laryngoscopy (DL) by paramedics and on the effects of the specific King Vision device on FPS and overall success (OS) in an emergency medical services (EMS) system with low intubation frequency and historically low success rates. OBJECTIVES: To evaluate the effect of an ongoing training program using the King Vision VL on FPS, OS, and success per attempt when compared with DL in one suburban EMS system with low historical intubation success rates. METHODS: We performed a retrospective analysis of electronic patient care reports in a suburban EMS system. We analyzed three metrics of intubation success before DL and after implementation of ongoing training with VL in both cardiac arrest and in all other indications: success per attempt, overall success, and first-pass success. We also performed an intention to treat analysis of these rates to account for protocol violations. RESULTS: During the study period, intubation was attempted on 514 patients. There was no difference between the DL and VL groups in age, weight, gender, or percentage receiving paralytic medications. There was improvement over DL with VL in each of the outcome measures: overall success (64.9 vs. 91.5%, p < 0.01), first-pass success (43.8% vs. 74.2%, p < 0.01), and success per attempt (44.4 vs. 71.2%, p < 0.01). A subgroup analysis by indication for intubation also showed improvement in all metrics for all indications. There were several protocol violations: 11 of 376 attempts that should have used VL (2.9%) but were done with DL. An intention to treat analysis was therefore done. Again, we saw an improvement in all metrics for all indications. CONCLUSION: In this suburban EMS system with historically low intubation success rates and low frequency of intubation, paramedics were able to improve all measures of intubation success using the King Vision video laryngoscope and an ongoing training program when compared with direct laryngoscopy.
INTRODUCTION: Intubation success by paramedics has historically been variable. The lack of first-pass success (FPS) has been associated with increased adverse events. Various video laryngoscope (VL) devices have been investigated to improve success among paramedics. Conflicting research exists on VL vs. direct laryngoscopy (DL) by paramedics and on the effects of the specific King Vision device on FPS and overall success (OS) in an emergency medical services (EMS) system with low intubation frequency and historically low success rates. OBJECTIVES: To evaluate the effect of an ongoing training program using the King Vision VL on FPS, OS, and success per attempt when compared with DL in one suburban EMS system with low historical intubation success rates. METHODS: We performed a retrospective analysis of electronic patient care reports in a suburban EMS system. We analyzed three metrics of intubation success before DL and after implementation of ongoing training with VL in both cardiac arrest and in all other indications: success per attempt, overall success, and first-pass success. We also performed an intention to treat analysis of these rates to account for protocol violations. RESULTS: During the study period, intubation was attempted on 514 patients. There was no difference between the DL and VL groups in age, weight, gender, or percentage receiving paralytic medications. There was improvement over DL with VL in each of the outcome measures: overall success (64.9 vs. 91.5%, p < 0.01), first-pass success (43.8% vs. 74.2%, p < 0.01), and success per attempt (44.4 vs. 71.2%, p < 0.01). A subgroup analysis by indication for intubation also showed improvement in all metrics for all indications. There were several protocol violations: 11 of 376 attempts that should have used VL (2.9%) but were done with DL. An intention to treat analysis was therefore done. Again, we saw an improvement in all metrics for all indications. CONCLUSION: In this suburban EMS system with historically low intubation success rates and low frequency of intubation, paramedics were able to improve all measures of intubation success using the King Vision video laryngoscope and an ongoing training program when compared with direct laryngoscopy.
Authors: Lukas E Wolf; José A Aguirre; Christian Vogt; Christian Keller; Alain Borgeat; Heinz R Bruppacher Journal: BMC Anesthesiol Date: 2017-01-10 Impact factor: 2.217
Authors: Moon Seong Baek; MyongJa Han; Jin Won Huh; Chae-Man Lim; Younsuck Koh; Sang-Bum Hong Journal: Ann Intensive Care Date: 2018-08-13 Impact factor: 6.925
Authors: Wim Breeman; Mark G Van Vledder; Michael H J Verhofstad; Albert Visser; Esther M M Van Lieshout Journal: Eur J Trauma Emerg Surg Date: 2020-02-19 Impact factor: 3.693