EBQ:Effect of video laryngoscopy on trauma patient survival
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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
There was no difference in hospital mortality between the two groups (Table 1). Approximately 93% of subjects survived to hospital discharge in the DL group, and 91% of subjects survived to hospital discharge in the GVL group (p = 0.43).
Secondary Outcomes
Among all patients, median intubation attempt duration in seconds was significantly higher for the GVL group than for the DL group. No meaningful differences between the two groups were found in the first-pass success rates (81% for DL and 80% for GVL, p = 0.46).
Subgroup analysis
When intubation times between junior residents and senior residents and attending were compared, a statistically longer intubation times across skill levels associated with use of the GlideScope was identified (data not shown). Among those with severe head injuries, median intubation attempt duration in seconds was also significantly higher for the GVL group than for the DL group. Correspondingly, this group also experienced a greater incidence of low oxygen saturations of 80% or less (27 [50%] of 54 for the GVL group and 15 [24%] of 63 for the DL group, p = 0.004).
Criticisms
Patients could be excluded according to attending discretion leading to noncompliance of protocol
CME