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The Impact of Video Laryngoscopy on the Clinical Learning Environment of Emergency Medicine Residents: A Report of 14,313 Intubations
Author(s) -
Monette Derek L.,
Brown Calvin A.,
Benoit Justin L.,
McMullan Jason T.,
Carleton Steven C.,
Steuerwald Michael T.,
Eyre Andrew,
Pallin Daniel J.
Publication year - 2019
Publication title -
aem education and training
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 9
ISSN - 2472-5390
DOI - 10.1002/aet2.10316
Subject(s) - intubation , medicine , confidence interval , laryngoscopy , logistic regression , odds ratio , emergency medicine , endotracheal intubation , significant difference , anesthesia
Background The introduction of video laryngoscopy ( VL ) may impact emergency medicine ( EM ) residents' intubation practices. Methods We analyzed 14,313 intubations from 11 EM training sites, July 1, 2002, to December 31, 2012, assessing the likelihood of first‐attempt success and likelihood of having a second attempt, by rank and device. We determined whether direct laryngoscopy ( DL ) first‐attempt success decreased as VL became more prevalent using a logistic regression model with proportion of encounters initiated with VL at that center in the prior 90 and 365 days as predictors of DL first‐attempt success. Results First‐attempt success by PGY ‐1s was 71% (95% confidence interval [ CI ] = 63% to 78%); PGY ‐2s, 82% (95% CI = 78% to 86%); and PGY ‐3+, 89% (95% CI = 85% to 92%). Residents' first‐attempt success rate was higher with the C‐ MAC video laryngoscope (C‐ MAC ) versus DL , 92% versus 84% (risk difference [ RD ] = 8%, 95% CI = 4% to 11%), but there was no statistical difference between the GlideScope video laryngoscope ( GVL ) and DL , 80% versus 84% ( RD = −4%, 95% CI = −10% to 1%). PGY ‐1s were more likely to have a second intubation attempt after first‐attempt failure with VL versus DL : 32% versus 18% ( RD = 14%, 95% CI = 5% to 23%). DL first‐attempt success rates did not decrease as VL became more prevalent. Conclusions First‐attempt success increases with training. Interns are more likely to have a second attempt when using VL . The C‐ MAC may be associated with increased first‐attempt success for EM residents compared with DL or GVL . The increasing prevalence of VL is not accompanied by a decrease in DL success.