Intubating Stylets in the Emergency Department: A Video Review of First-pass Success and Time.

Area of Science:

• Emergency Medicine
• Critical Care
• Anesthesiology

Background:

• Effective airway management is crucial for patient outcomes in the emergency department (ED).
• The choice of intubating stylet significantly influences airway management success and duration.
• Evaluating equipment trends for first-pass success and intubation duration is essential.

Purpose of the Study:

• To compare the first-pass success rates and intubation durations of three common intubating stylets.
• To analyze trends in equipment selection for airway management.
• To assess physician preferences for different intubating stylets.

Main Methods:

• Retrospective observational study of 575 intubation videos recorded via video laryngoscopy.
• Analysis of device type, number of attempts, and time to successful intubation.
• Survey of 52 physicians regarding their intubation modality preferences.

Main Results:

• The malleable stylet had the highest first-pass success rate (94.9%), followed by the hyperangulated stylet (93.2%), and the bougie (88.2%).
• The bougie had the longest median intubation time (40.5 seconds), while malleable and hyperangulated stylets had shorter, similar times (31 seconds).
• Physician preference favored the malleable stylet (55.8%).

Conclusions:

• The malleable stylet demonstrated superior first-pass success and more consistent intubation times compared to the bougie in the ED setting.
• Physician preference aligns with the malleable stylet's performance, suggesting its utility in airway management.
• Institutional familiarity and clinician preference are key factors influencing the selection of intubation equipment for optimal outcomes.