Changes in Cormack-Lehane View Between First and Second Emergency Department Intubation Attempts

Area of Science:

• Emergency Medicine
• Anesthesiology
• Airway Management

Background:

• Effective airway management is crucial in emergency settings.
• The Cormack-Lehane classification assesses glottic view during intubation.
• Understanding changes in glottic view between attempts informs clinical practice.

Purpose of the Study:

• To evaluate the agreement of glottic views (Cormack-Lehane grade) between the first and second intubation attempts.
• To compare view agreement when different providers perform the attempts versus the same provider.

Main Methods:

• Retrospective cohort study of 640 emergency department (ED) intubations from the National Emergency Airway Registry (2016-2018).
• Analysis of adult patients receiving sedative and paralytic agents with multiple intubation attempts.
• Exclusion of cases with altered equipment, positioning, or manipulation between attempts.
• Categorization into 'different intubator' and 'same intubator' cohorts.

Main Results:

• The Cormack-Lehane grade remained the same in 50.0% of cases when different providers attempted intubation (kappa = 0.40).
• The glottic view was consistent in 72.0% of cases when the same provider performed both attempts (kappa = 0.53).
• Significant changes in glottic view occurred in half of cases with provider change and over a quarter with the same provider.

Conclusions:

• Glottic view consistency is moderate between sequential intubation attempts in the ED.
• Provider changes significantly impact glottic view stability.
• These findings underscore the dynamic nature of airway visualization during difficult intubations.