Jestin N. Carlson

Does the Use of Video Laryngoscopy Improve Intubation Outcomes

TUDY SELECTION he authors selected randomized rials comparing at least 1 video aryngoscope with direct aryngoscopy in the clinical setting. hey excluded mannequin studies nd observational studies. Studies ere included if any of the 3 elected outcomes were reported: verall intubation success, time to ntubation, and quality of the glottic iew. Study authors were ontacted individually to obtain nformation not reported in the riginal articles.

Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

Introduction Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII). Methods We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15]. Conclusion In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.

Osteopathic emergency medicine programs infrequently publish in high-impact emergency medicine journals.

Introduction Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. Methods We performed a retrospective literature review using the Journal Citation Report database and identified the top five journals in the category of ‘Emergency Medicine’ by their 2011 Impact Factor. We examined all publications from each journal for 2011. For each article we recorded article type, authors’ names, position of authorship (first, senior or other), the author’s degree and affiliated institution. We present the data in raw numbers and percentages. Results The 2011 EM journals with the highest impact factor were the following: Annals of Emergency Medicine, Resuscitation, Journal of Trauma, Injury, and Academic Emergency Medicine. Of the 9,298 authors published in these journals in 2011; 1,309 (15%) claimed affiliation with U.S.-based EM programs, of which 16 (1%) listed their affiliations with eight different osteopathic EM programs. The 16 authors claimed affiliation with 8 of 46 osteopathic EM programs (17%), while 1,301 authors claimed affiliation with 104 of 148 (70%) U.S.-based allopathic programs. Conclusion Authors from osteopathic EM programs are under-represented in the top EM journals. With the pending ACGME/AOA merger, there is a significant opportunity for improvement in the rate of publication of osteopathic EM programs in top tier EM journals.

Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation.

As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest?

Of 3,454 potential studies, the authors included 10 observational studies meeting inclusion, encompassing 34,533 intubation patients and 41,116 supraglottic airway patients. Intubation was associated with greater odds of return of spontaneous circulation, survival to hospital admission, and neurologically intact survival to hospital discharge compared with supraglottic airway; however, there was substantial heterogeneity reported for all of the outcomes except for the neurologic outcome (I1⁄420%). In the sensitivity analysis based on quality (ie, excluding the very-lowquality studies), intubation was associated only with greater odds of neurologically intact survival to hospital discharge.