Premium
Effect of the introduction of C‐MAC videolaryngoscopy on first‐pass intubation success rates for emergency medicine registrars
Author(s) -
Mackie Stephanie,
Moy Fen,
Kamona Sinan,
Jones Peter
Publication year - 2020
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13329
Subject(s) - medicine , intubation , orotracheal intubation , odds ratio , confidence interval , first pass , emergency department , incidence (geometry) , retrospective cohort study , emergency medicine , anesthesia , physics , arithmetic , mathematics , psychiatry , optics
Abstract Objectives The present study investigated the impact of introducing C‐MAC videolaryngoscopy as the standard method of visualising glottic structures on first‐pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. Methods In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C‐MAC videolaryngoscopy were compared. The primary outcome was first‐pass intubation success rates by EM registrars. Secondary outcomes were first‐pass success rates by all intubators, and incidence of any complication of intubation. Results There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first‐pass success from 59.2% (95% confidence interval [CI] 44.1–68.8%) to 85.1% (95% CI 76.0–91.2%, P < 0.001) after the introduction of C‐MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06–5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85–10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C‐MAC (28.9%, 95% CI 19.9–40.0% prior to C‐MAC introduction; 16.1%, 95% CI 9.7–25.3% after; P = 0.048). Conclusion This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators.