The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

VIDEO-ASSISTED LARYNGOSCOPY MAY DECREASE ESOPHAGEAL INTUBATION IN AN EMERGENCY MEDICINE RESIDENCY PROGRAM

Joseph B. Shepherd1, Jhaymie L. Cappiello1, Michael A. Gentile1, Neil R. MacIntyre1



Background: Video laryngoscopy is shown to improve laryngeal view over direct laryngoscopy, add benefit to teaching intubation, and may decrease procedure learning curve.(1,2,3) These advantages led our emergency medicine residency program to obtain the Storz DCI® Video Intubation System. Respiratory Care Practitioners (RCP's), part of the resident airway training team, obtained IRB approval to develop and review a procedure database to evaluate the effectiveness of this device.

Methods:
Attending physicians, residents and RCP's were trained on the device. Residents would use direct visualization technique when using the videoscope (VS) and the monitor would facilitate the trainers' evaluation and instruction. Residents were allowed 2-3 intubation attempts before the RCP or attending physician would take over and perform the intubation (an unsuccessful resident procedure). The database recorded resident airway procedures (RAP) with and without VS, number of laryngoscopies per RAP, and tracheal/esophageal intubations over a six month period. Population included adult medical and trauma patients. Equipment use was determined by availability.

Results:
see table

Conclusion:
Residents' successful tracheal intubation and laryngoscopy insertion rate were clinically similar. The VS esophageal intubations appear to be the result of operator error. One VS esophageal intubation occurred due to operator not heeding the advice of monitor observers and the other with observers not actively viewing the monitor. Based on this data, the VS showed no effect on resident intubation success rate but did appear to lower the incidence of esophageal intubation. Therefore, the use of these scopes could decrease adverse events for patients' during resident intubation training and would be a good teaching tool for RCPs'.

1. Kaplan, Comparison of direct and video-assisted views of the larynx during routine intubation. Journal of Clinical Anesthesia (18) 2006,357-362
2. Low, The use of the BERCI DCI Video Laryngoscope for teaching novices' direct laryngoscopy and tracheal intubation. Anesthesia (63) 2008, 195-201