EBQ:Effect of video laryngoscopy on trauma patient survival
PubMed
Clinical Question
Does the use of GlideScope video laryngoscopy affect survival to hospital discharge in adult patients requiring emergency airway management?
Conclusion
Use of the GlideScope did not influence survival to hospital discharge among all patients and was associated with longer intubation times than direct laryngoscopy. Among the video laryngoscope cohort, a smaller subgroup of severe head injury trauma patients identified retrospectively seemed to be associated with a greater incidence of hypoxia of 80% or less and mortality.
Design
Prospective randomized controlled trial
Population
Adult patients in trauma resuscitation unit at a trauma center requiring emergency intubation.
Inclusion Criteria
All adult patients who required tracheal intubation according to Eastern Association for the Surgery of Trauma guidelines and included airway obstruction, hypoventilation, severe hypoxemia, GCS less than 8 and hemorrhagic shock. Altered mental status, combativeness, and extreme pain were also criteria.
Exclusion Criteria
Minors, patients with suspected laryngeal trauma or extensive maxillofacial injury who required an immediate surgical airway and patients with known or strongly suspected spinal cord injury for whom awake flexible fiber-optic intubation was indicated. The study also excluded patients in cardiac arrest on arrival as well as those who died in the TRU.
Interventions
All patients received same pre-oxygenation and RSI protocols. Intubation through DL or GlideScope were performed primarily by resident anesthesiologists and emergency physicians. Remainder intubations were performed by attending anesthesiologists.
Outcome
Primary Outcomes
Secondary Outcomes
Secondary outcomes were intubation attempt duration and intubation first-pass success rate.