Does the use of video laryngoscopy improve first-time success rates or overall success rates in HEMS [abstract]?
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Background: Prehospital pediatric ETI has shown no survival benefits compared to bag-valve mask ventilation. However, the use of video laryngoscopy (VL) has not been studied in this setting. We hypothesized that VL (CMAC®) would significantly increase first attempt and final success rates over direct laryngoscopy (DL). Methods: Pediatric patients (age <18) transported between January 1, 2010 and October 31, 2015 with an attempted intubation were identified. Demographics (age group, sex), first attempt success and total attempts by intubation type were abstracted. Age groups were categorized as birth-12 months, 13 months–5 years, 6–12 years, and 13–17 years. Basic comparisons of categorical variables were completed using unadjusted Chi-squared and unadjusted t-tests for continuous variables. Stratified ANOVAs were calculated to examine total attempts with each device based on age group. Results: Sixty-six pediatric patient runs were abstracted (35 DL and 31 VL). There were no significant differences between the DL and VL groups based on gender (DL, 49% male vs. VL, 61% male, p = 0.30) or age group (p = 0.29). Analyses of first attempt success rate between DL and VL showed no difference (DL, 74.29% success vs. VL, 74.19% success, p = 0.993). There was no difference between final success rate between DL and VL (DL, 94.74% vs. VL 96.77%, p = 0.325). Analyses of first attempt success by age group was not significant (p = 0.715) with the likelihood of an attempt being equivalent for all age categories. Statistical results examining the total number of attempts by age group for DL and VL also showed no significant differences (DL, F(3,31) = 1.25, p = 0.31 vs. VL, F(3,27) = 0.47, p = 0.71). 100% of patients in both groups were successfully ventilated. Conclusions: This trial is the first to evaluate VL in the prehospital, pediatric population. The hypothesis is disproven, video laryngoscopy did not improve first time success or final success rate. Given our subjective experience in the adult cadaver lab, these results surprised us. We feel they may be due to the limitation of this being a small trial. We recommend a larger study to fully evaluate the use of field VL in the pediatric population.