Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy

Videolaryngoscopy has become a popular method of intubation in the Emergency Department (ED), however, little research has compared this technique with direct laryngoscopy (DL).

To compare the success rates of GlideScope (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) and DL in emergent airways with known difficult airway predictors (DAPs).

We evaluated 772 consecutive ED intubations over a 23-month period. After each intubation, the physician completed a data collection form that included: demographics, DAPs, Cormack-Lehane view, optical clarity, lens contamination, and complications. DAPs included: cervical immobility, obesity, small mandible, large tongue, short neck, blood or vomit in the airway, tracheal edema, secretions, and facial or neck trauma. Primary outcome was first-attempt success rates. Multivariate logistic regression was performed to evaluate the odds of failure for DL compared to GVL.

First-attempt success rate with DL was 68%, GVL 78% (Fisher's exact test, p = 0.001). Adjusted odds of success of GVL compared to DL on first attempt equals 2.20 (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.51-3.19). After statistically controlling for DAPs, GVL was more likely to succeed on first attempt than DL (OR 3.07, 95% CI 2.19-4.30). Logistic regression of DAPs showed that the presence of blood, small mandible, obesity, and a large tongue were statistically significant risk factors for decreasing the odds of success with DL and increasing the odds of success of GVL.

For difficult airways with the presence of blood or small mandible, or a large tongue or obesity, GVL had a higher success rate at first attempt than DL.