Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter...

Area of Science:

• Emergency Medicine
• Medical Devices
• Airway Management

Background:

• Videolaryngoscopy is crucial for endotracheal intubation.
• Performance and usability of videolaryngoscopes vary, especially in prehospital settings.
• Limited data exists on the comparative effectiveness of different videolaryngoscopes in the prehospital environment.

Purpose of the Study:

• To compare the performance of three portable videolaryngoscopes in prehospital emergency intubations.
• To evaluate intubation success rates, glottis visualization, and device handling.
• To determine the most effective videolaryngoscope for emergency physician use.

Main Methods:

• Prospective, randomized, multicenter study at 4 German prehospital emergency centers.
• 168 adult patients requiring emergency intubation were randomized to A.P. Advance, C-MAC PM, or KingVision videolaryngoscopes.
• Primary outcome: overall intubation success. Secondary outcomes: first-attempt success, glottis visualization, device handling.

Main Results:

• Overall intubation success rates were 96% (A.P. Advance), 97% (C-MAC), and 61% (KingVision) (P < .001).
• First-attempt success rates were 86% (A.P. Advance), 85% (C-MAC), and 48% (KingVision) (P < .001).
• Glottis visualization was comparable; however, KingVision required more alternative devices for successful intubation.

Conclusions:

• Significant variation exists in prehospital videolaryngoscope performance.
• A.P. Advance and C-MAC showed superior intubation success rates compared to KingVision.
• While visualization was adequate, the channeled blade KingVision presented greater intubation difficulty.