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The Impact of a Soiled Airway on Intubation Success in the Emergency Department When Using the GlideScope or the Direct Laryngoscope
Author(s) -
Sakles John C.,
Corn G. Judson,
Hollinger Patrick,
Arcaris Brittany,
Patanwala Asad E.,
Mosier Jarrod M.
Publication year - 2017
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13160
Subject(s) - medicine , intubation , emergency department , odds ratio , confidence interval , airway , airway management , anesthesia , cohort , cohort study , psychiatry
Background The objective was to determine the impact of a soiled airway on firstpass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department ( ED ). Methods Data were prospectively collected on all patients intubated in an academic ED from July 1, 2007, to June 30, 2016. Patients ≥ 18 years of age, who underwent rapid sequence intubation by an emergency medicine resident with the GlideScope or the direct laryngoscope, were included in the analysis. Data were stratified by device used (GlideScope or direct laryngoscope). The primary outcome was firstpass success. Patients were categorized as those without blood or vomitus ( CLEAN ) and those with blood or vomitus ( SOILED ) in their airway. Multivariate regression models were developed to control for confounders. Results When using the GlideScope, the firstpass success was lower in the SOILED group (249/306; 81.4%) than the in CLEAN group (586/644, 91.0%; difference = 9.6%; 95% confidence interval [ CI ] = 4.7%–14.5%). Similarly, when using the direct laryngoscope, the firstpass success was lower in the SOILED group (186/284, 65.5%) than in the CLEAN group (569/751, 75.8%; difference = 10.3%; 95% CI = 4.0%–16.6%). The SOILED airway was associated with a decreased firstpass success in both the GlideScope cohort (adjusted odds ratio [ aOR ] = 0.4; 95% CI = 0.3–0.7) and the direct laryngoscope cohort ( aOR = 0.6; 95% CI = 0.5–0.8). Conclusion Soiling of the airway was associated with a reduced firstpass success during emergency intubation, and this reduction occurred to a similar degree whether using either the GlideScope or the direct laryngoscope.