Evaluation of Prehospital Emergency Intubations Using Videolaryngoscopes
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 422
- Locations
- 1
- Primary Endpoint
- First attempt intubation success rate
Study Overview
Brief Summary
The Investigators' knowledge about pre-hospital emergency intubations is still limited. Various factors such as the average and the normal range of intubation time are still unknown. Since its launch Rega videotapes all intubation attempts with the C-MAC videolaryngoscope. The investigators prospectively analysed all routinely recorded intubation videos during one year performed by the Rega crews. The investigators analysed different parameters such as first pass success rate and the time to successfully intubate alongside with others. The goal was to find out more about this difficult procedure, about the problems which regularly occur and on what should be put particular emphasis during training.
Detailed Description
Pre-hospital emergency intubations are especially hazardous. The incidence of unanticipated difficult airways is higher (9,3 % of prehospital intubations are more difficult than anticipated). The first attempt intubation success rates are lower and the rate of complications compared to in-hospital emergency intubations is higher.
There is conflicting evidence if first attempt intubation success rate in prehospital intubations differs between intubations performed by videolaryngoscopy and direct laryngoscopy. On the other hand in pre-hospital airway management, the use of a C-MAC videolaryngoscope improved the visualization of glottic structures significantly.
The C-MAC has recently launched a new version, which allows videotaping of intubations. Rega decided to videotape all intubation attempts for legal purposes and quality control. These videos are stored at a Rega-based secure central database.
The Investigators knowledge there is only one video-enhanced retrospective analyses of a limited number of videolaryngoscopic pre-hospital intubations.
So far, there is no video-enhanced prospective analysis of first attempt intubation success rates or of the time necessary for successful intubation with videolaryngoscopes in the pre-hospital setting available. Therefore, the investigators intend to determine the exact first attempt intubation success rate and the time necessary to successfully intubate, alongside with parameters such as the Cormack/Lehane grade, blade position (Macintosh vs Miller) and others (e.g. difficulties during intubation) in the pre-hospital physician-staffed HEMS-setting. The investigators' goal is to learn more about what is actually happening during prehospital intubations and what type of difficulties may occur.
Study Design
- Study Type
- Observational
- Observational Model
- Other
- Time Perspective
- Prospective
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •All videos routinely taken from intubations performed during 1 year at the Swiss Air Rescue (Rega) at all 13 helicopter bases
Exclusion Criteria
- •Patients who were intubated primarily using other devices without a camera
- •Intubations that were not recorded (missing data).
Outcomes
Primary Outcomes
First attempt intubation success rate
Time Frame: Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured
Rate of a successful intubation at first attempt
Secondary Outcomes
- Best C/L(Cormack/ Lehane 1-4) grade and best POGO (percent of glottis Opening 0 - 100 %) score(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Additional Airway devices used(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Number of glottic hits(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Overall success rate(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Time intervals during intubation(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Fogging of the camera(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Injury of the pharyngeal mucose due to the blade(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Open or Closed vocal cords(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Oesophageal intubation(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Number of intubation attempts(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Blade positioning(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Unintended blade positions(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)
- Secretion in the mouth and difficulties in visualisation because of it(Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured)