First attempt intubation success rate

Joshua R Lupton, Robert H Schmicker, Shannon Stephens, Jestin N Carlson, Clifton Callaway, Heather Herren, Ahamed H Idris, George Sopko, Juan C J Puyana, Mohamud R Daya, Henry Wang, Matt Hansen
BACKGROUND: While emergency medical services (EMS) often use endotracheal intubation (ETI) or supraglottic airways (SGA), some patients receive only bag-valve-mask (BVM) ventilation during out-of-hospital cardiac arrests (OHCA). Our objective was to compare patient characteristics and outcomes for BVM ventilation to advanced airway management (AAM) in adults with OHCA. METHODS: Using data from the Pragmatic Airway Resuscitation Trial, we identified patients receiving AAM (ETI or a SGA), BVM ventilation only (BVM-only), and BVM ventilation as a rescue after at least one failed attempt at advanced airway placement (BVM-rescue)...
March 27, 2020: Academic Emergency Medicine
Jatin Lal, Teena Bansal, Gaurav Dhawan, Susheela Taxak, Manu Smriti, Jyoti Sharma, Deepali Thaper
Background and Aims: The problem of difficult and failed intubation led to increased development of equipment for airway management. A number of supraglottic airways have now been developed to facilitate the passage of tracheal tubes. Conventional PVC tracheal tubes are recommended for intubation through the air-Q ILA. No study has compared different PVC tubes for blind intubation through air-Q ILA. Thus, we undertook this prospective, randomised, single blind study to compare two PVC tracheal tubes with different designs viz...
January 2020: Journal of Anaesthesiology, Clinical Pharmacology
Thomaz Bittencourt Couto, Amélia G Reis, Sylvia C L Farhat, Vitor E L Carvalho, Claudio Schvartsman
OBJECTIVE: To determine the effect of a training program using simulation with mastery learning on the performance of residents in pediatric intubations with videolaryngoscopy. METHOD: Retrospective cohort study carried out in a tertiary pediatric hospital between July 2016 and June 2018 evaluating a database that included the performance of residents before and after training, as well as the outcome of tracheal intubations. A total of 59 pediatric residents were evaluated in the pre-training with a skills' checklist in the scenario with an intubation simulator; subsequently, they were trained individually using a simulator and purposeful practice in the department itself...
March 7, 2020: Jornal de Pediatria
John Glasheen, Jeff Hooper, Andrew Donohue, Emmeline Finn, Bronwyn Murray-Smith, Renée Bolot, Mark Edwards
INTRODUCTION: First attempt intubation success is used by many prehospital services as a marker of quality and safety. An increasing complication rate is associated with repeated intubation attempts. The aim of this study was to identify changes to intubation technique following a failed intubation attempt. METHODS: LifeFlight Retrieval Medicine provides aeromedical retrieval services in Queensland, Australia. This retrospective study identified cases of failed intubation attempts from an electronic database registry over a 41-month period from March 2015 to July 2018...
March 5, 2020: Emergency Medicine Journal: EMJ
Wim Breeman, Mark G Van Vledder, Michael H J Verhofstad, Albert Visser, Esther M M Van Lieshout
PURPOSE: The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS)  of 3 using video laryngoscopy versus direct laryngoscopy. METHODS: A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances...
February 19, 2020: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Martina Mudri, Andrew Williams, Fran Priestap, Jacob Davidson, Neil Merritt
PURPOSE: Rapid sequence intubation (RSI) drugs, such as propofol, affect clinical outcomes, but this has not been examined in the pediatric population. This descriptive study compares the outcomes associated with intubation drugs used in pediatric traumatic brain injury (TBI) patients. METHODS: A retrospective chart review and descriptive analysis of intubated TBI patients, ages 0-17, admitted to Children's Hospital London Health Sciences Centre (LHSC) from January 2006-December 2016 was performed...
January 31, 2020: Journal of Pediatric Surgery
Amr Morsi, Andres Maldonado, Dennis Lal, Ahsan Nv Moosa, Elia Pestana-Knight, William Bingaman
BACKGROUND: Hemispherectomy has been shown to be successful in treating medically intractable epilepsy, with favorable seizure-free outcome. However, the procedure remains to be technically challenging with high rates of in-hospital complications. We present a unique case of functional hemispherectomy complicated by diffuse cerebral vasospasm and subsequent death in a patient with COL4A1 gene mutation. CASE DESCRIPTION: Seventeen year-old-male presented with right hemispheric epilepsy and a previously diagnosed autosomal dominant heterozygous COL4A1 gene mutation (c...
February 11, 2020: World Neurosurgery
Yukari Goto, Tadahiro Goto, Hiroshi Okamoto, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa
Aim: It remains unclear whether physicians should change intubation approaches after the failed first attempt. We aimed to determine the rescue intervention approaches associated with a higher success rate at the second attempt in the emergency department (ED). Methods: We analyzed the data from a prospective, multicenter, observational study - the second Japanese Emergency Airway Network Study. The current analysis included all patients who underwent emergency intubation from February 2012 through November 2017...
January 2020: Acute Medicine & Surgery
Michèle Chan, Christophe A Fehlmann, Mathieu Pasquier, Laurent Suppan, Georges L Savoldelli
OBJECTIVES: In the prehospital setting, endotracheal intubation (ETI) is sometimes required to secure a patient's airways. Emergency ETI in the field can be particularly challenging, and success rates differ widely depending on the provider's training, background, and experience. Our aim was to evaluate the ETI success rate in a resident-staffed and specialist-physician-supervised emergency prehospital system. METHODS: This retrospective study was conducted on data extracted from the Geneva University Hospitals' institutional database...
January 16, 2020: Journal of Clinical Medicine
Mehmet Çakir, Erhan Özyurt
BACKGROUND/AIM: In recent years, videolaryngoscopes (VL) have emerged as alternative devices to direct laryngoscopes (DL) in difficult intubation situations. Therefore, we aimed to compare the Macintosh DL and McGrath VL in terms of the glottic image quality, intubation success, intubation time, hemodynamic response after intubation, and complications in bariatric surgery patients. MATERIAL AND METHODS: After obtaining approval by the ethics committee and receiving informed consent, we recorded the demographic and physical data of patients undergoing bariatric surgery...
January 14, 2020: Turkish Journal of Medical Sciences
Leigh D White, Christopher Thang, Anthony Hodsdon, Thomas M Melhuish, Fiona A Barron, M Guy Godsall, Ruan Vlok
BACKGROUND: The safety and adverse event rate of supraglottic airway (SGA) devices for cesarean delivery (CD) is poorly characterized. The primary aims of this review were to determine whether the first-pass success was higher and time to insertion for SGA was faster than endotracheal intubation for elective CD. The secondary aim was to determine the airway-related adverse event rate associated with SGA use compared to endotracheal intubation in elective CD under general anesthesia (GA)...
January 8, 2020: Anesthesia and Analgesia
Ryan Pedigo, Juliana Tolles, Daena Watcha, Amy H Kaji, Roger J Lewis, Elena Stark, Jaime Jordan
INTRODUCTION: The optimal method to train novice learners to perform endotracheal intubation (ETI) is unknown. The study objective was to compare two models: unembalmed cadaver vs simulation manikin. METHODS: Fourth-year medical students, stratified by baseline ETI experience, were randomized 1:1 to train on a cadaver or simulation manikin. Students were tested and video recorded on a separate cadaver; two reviewers, blinded to the intervention, assessed the videos...
December 9, 2019: Western Journal of Emergency Medicine
Michał Bączek, Michalina Zagańczyk-Bączek
BACKGROUND: The aim of this study was to compare three intubation methods during cardiopulmonary resuscitation using an adult-manikin. METHODS: Thirty-nine paramedics were included in this study. Each participant performed endotracheal intubation during continuous chest compressions using 3 different methods: conventional Macintosh laryngoscope without additional intubation aids (MAC), conventional Macintosh laryngoscope with gum-elastic bougie (GEB), or flexible tip bougie (FTB)...
January 2020: Medicine (Baltimore)
Luc E Vanlinthout, Bénédicte Geniets, Jacques J Driessen, Vera Saldien, Raphaël Lapré, Johan Berghmans, Uwimpuhwe Germaine, Niel Hens
BACKGROUND: The benefit of using neuromuscular blocking agents to facilitate tracheal intubation in children remains unclear due to variations in design, treatments, and results among trials. By combining the available evidence, we aimed to establish whether scientific findings are consistent and can be generalized across various populations, settings and treatments. METHODS: A systematic search for randomized controlled trials (RCTs), related to the use of neuromuscular blocking agents for tracheal intubation in ASA Class I-II participants (0-12 y) was performed...
December 30, 2019: Paediatric Anaesthesia
Triveni M Rangaswamy, Avnish Bharadwaj, Priyanka Jain
Background: Ambu® Aura-i™, a recently introduced second generation supraglottic airway device has been designed to function as an independent ventilatory device as well as a conduit for passage of conventional cuffed tracheal tubes through it. There is dearth of literature on experience of tracheal intubation through intubating laryngeal mask airway (ILMA) in paediatric age group. This study was conducted to study the ventilatory effectiveness and the intubating characteristics of Ambu® Aura-i™ in paediatric patients...
October 2019: International Journal of Critical Illness and Injury Science
Archana Endigeri, Anilkumar Ganeshnavar, Bvs Varaprasad, Y H Shivanand, Basavaraja Ayyangouda
Background and Aims: BlockBuster® Laryngeal Mask Airway, a newer supraglottic airway device, is claimed to be an efficient conduit for endotracheal intubation. Intubating laryngeal mask airway (LMA) is an established device for the same. This randomised study was undertaken to evaluate the success rate of blind intubation using either of these LMAs. Methods: Sixty patients of age group 20-60 years undergoing general anaesthesia were randomised in 2 groups, of 30 patients each, for tracheal intubation using either BlockBuster® LMA (Group B) or the Intubating LMA Fastrach® (Group F)...
December 2019: Indian Journal of Anaesthesia
Bertrand Guihard, Charlotte Chollet-Xémard, Philippe Lakhnati, Benoit Vivien, Claire Broche, Dominique Savary, Agnes Ricard-Hibon, Pierre-Jean Marianne Dit Cassou, Frédéric Adnet, Eric Wiel, Juliette Deutsch, Cindy Tissier, Thomas Loeb, Vincent Bounes, Emmanuel Rousseau, Patricia Jabre, Laetitia Huiart, Cyril Ferdynus, Xavier Combes
Importance: Rocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium. Objective: To assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations...
December 17, 2019: JAMA: the Journal of the American Medical Association
Whei Jung, Joonghee Kim
STUDY OBJECTIVE: Endotracheal intubation is frequently performed in emergency departments (EDs). First-pass success is important because repeated attempts are associated with poor outcomes. We sought to identify factors associated with first-pass success in emergency endotracheal intubation. METHODS: We analyzed emergency orotracheal intubations on adult patients in an ED located in South Korea from Jan. 2013 to Dec. 2016. Various operator-, procedure- and patient-related factors were screened with univariable logistic regression...
January 2020: American Journal of Emergency Medicine
Luca Cabrini, Martina Baiardo Redaelli, Martina Filippini, Evgeny Fominskiy, Laura Pasin, Margherita Pintaudi, Valentina Paola Plumari, Alessandro Putzu, Carmine D Votta, Ottavia Pallanch, Lorenzo Ball, Giovanni Landoni, Paolo Pelosi, Alberto Zangrillo
BACKGROUND: tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky. OBJECTIVES: to compare tracheal intubation techniques in adult patients at risk for secondary cervical spinal cord injury undergoing surgery. Primary outcome was first-attempt failure rate. Secondary outcomes were time to successful intubation and procedure complications. DESIGN: systematic review and meta-analysis of RCTs with trial sequential analysis (TSA)...
December 14, 2019: Acta Anaesthesiologica Scandinavica
Filippo Sanfilippo, Francesco Sgalambro, Giuseppe Chiaramonte, Cristina Santonocito, Gaetano Burgio, Antonio Arcadipane
Objective: There are several airway devices available for difficult tracheal intubation (DTI) management, but the failure rate remains high. The use of laryngoscopy to facilitate the fibreoptic-bronchoscope intubation (CLBI) has been increasingly reported in DTI situations, but it has not been formally studied yet. Methods: We designed a single-centre simulation study on DTI (neck rigidity and tongue oedema) comparing three techniques: direct laryngoscopy (DL), video-laryngoscopy (VLS) and CLBI...
December 2019: Turkish Journal of Anaesthesiology and Reanimation
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