Paramedic time to endotracheal tube placement using a video laryngoscope [abstract]
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Background: Time to placement of an endotracheal tube in the prehospital setting has been difficult to objectively measure and report. Use of video laryngoscope devices with recording capabilities allows for precise measurement of time to placement via video analysis of placement attempts. Objectives: To descriptively report time to endotracheal tube placement by paramedics in real patients treated in the prehospital setting. Methods: This post-hoc analysis is from an IRB-approved, multiagency, prospective, non-randomized, cross-over trial comparing success rates and complications for two video laryngoscope systems (Storz CMAC, Macintosh #4 blade; King VISIONTM, Size 3). Paramedics were instructed to record all advanced airway placement attempts with the CMAC device. Research staff downloaded recorded placement attempts and measured the following placement intervals (seconds): 1) blade in mouth to passage of the ET tube past the vocal cords, or 2) blade in mouth to removal of blade when ET attempts were unsuccessful. First attempt and overall attempt success rates were descriptively reported. Median times and interquartile ranges to successful or unsuccessful placement attempts were calculated. Results: Thirty-four of 66 (52%) CMAC placement attempts during the study period had recordings available for initial review. Eleven recordings were subsequently excluded (four still images only, seven poor video quality), leaving 23 recordings for evaluation. First attempt success rate was 61% (14/23), with an overall success rate of 83% (19/ 23). The median first attempt time to successful placement was 33 seconds (IQR 17.5-64.5), with a median second attempt time to successful placement of 35 seconds (IQR 31-83). The median time for unsuccessful first placement attempts was 46 seconds (IQR 28-80). Only three of the six cases with more than one placement attempt had video available from both placement attempts (median total time = 85 seconds). Conclusion: This is the first report of independent, objectively measured paramedic time to advanced airway placement using a video laryngoscope system in the prehospital setting. Recording video laryngoscope systems appear to be a valuable tool in assessment of intubation times in prehospital medicine.