The Impact of a Soiled Airway on Intubation Success in the Emergency Department when using the GlideScope or the Direct Laryngoscope

Abstract

Background

To determine the impact of a soiled airway on first pass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department.

Methods

Data were prospectively collected on all patients intubated in an academic emergency department from July 1, 2007 to June 30, 2016. Patients ≥18 years of age, who underwent rapid sequence intubation with the GlideScope or the direct laryngoscope were included in the analysis. Data were stratified by device used (GlideScope or direct laryngoscope). The primary outcome was first pass success. Patients were categorized as those without blood or vomitus (CLEAN) and those with blood or vomitus (SOILED) in their airway. Multivariate regression models were developed to control for confounders.

Results

When using the GlideScope the first pass success was lower in the SOILED group (249/306; 81.4%) than the in CLEAN group (586/644; 91.0%) (difference 9.6%; 95% CI: 4.7 to 14.5). Similarly, when using the direct laryngoscope, the first pass success was lower in the SOILED group (186/284; 65.5%) than in the CLEAN group (569/751; 75.8%) (difference 10.3%; 95% CI: 4.0 to 16.6). The SOILED airway was associated with a decreased first pass success in both the GlideScope cohort (aOR 0.4; 95% CI: 0.3 to 0.6) and the direct laryngoscope cohort (aOR 0.6; 95% CI: 0.5 to 0.8).

Conclusion

Soiling of the airway was associated with a reduced first pass success during emergency intubation and this reduction occurred to a similar degree whether using either the GlideScope or the direct laryngoscope.

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