The Impact of a Soiled Airway on Intubation Success in the Emergency Department When Using the GlideScope or the Direct Laryngoscope
Abstract
Background: The objective was to determine the impact of a soiled airway on firstpass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department (ED). Methods: Data were prospectively collected on all patients intubated in an academic ED from July 1, 2007, to June 30, 2016. Patients ≥ 18 years of age, who underwent rapid sequence intubation by an emergency medicine resident 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 firstpass 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 firstpass success was lower in the SOILED group (249/306; 81.4%) than the in CLEAN group (586/644, 91.0%; difference = 9.6%; 95% confidence interval [CI] = 4.7%–14.5%). Similarly, when using the direct laryngoscope, the firstpass 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%–16.6%). The SOILED airway was associated with a decreased firstpass success in both the GlideScope cohort (adjusted odds ratio [aOR] = 0.4; 95% CI = 0.3–0.7) and the direct laryngoscope cohort (aOR = 0.6; 95% CI = 0.5–0.8). Conclusion: Soiling of the airway was associated with a reduced firstpass 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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The presence of airway contamination with either blood or vomitus has been shown to decrease the rate of first-attempt intubation success, regardless of the device used.
“The presence of airway contamination with either blood or vomitus has been shown to decrease the rate of first-attempt intubation success, regardless of the device used.54”
From Airway Management in Trauma (2018) · cites this paper as [54]
Sakles and colleagues retrospectively reviewed more than 4600 intubations and demonstrated that, although airway contamination was associated with a decreased first-attempt success rate, this was irrespective of the choice of GlideScope or DL as the first-attempt device used.
“Recently, Sakles and colleagues 54 retrospectively reviewed more than 4600 intubations and demonstrated that, although airway contamination was associated with a decreased first-attempt success rate, this was irrespective of the choice of GlideScope or DL as the first-attempt device used.”
From Airway Management in Trauma (2018) · cites this paper as [54]
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Sakles, J. C., Corn, G. J., Hollinger, P., Arcaris, B., Patanwala, A. E., & Mosier, J. M.
- Affiliations
- University of Arizona (US)
- Corresponding author
- Sakles, John C.
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2017-03-17
- Volume
- 24
- Issue
- 5
- Pages
- 628-636
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W2573446363
- Cited by
- 56
- References
- 0
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 7 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 4 · 2018: 7 · 2017: 1
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
- Keywords
- intubation success, GlideScope, video laryngoscopy, direct laryngoscopy, rapid sequence intubation, emergency department intubation, airway management
- MeSH terms
- Adult, Aged, Blood, Emergency Service, Hospital, Female, Humans, Intubation, Intratracheal, Laryngoscopy, Male, Middle Aged, Prospective Studies, Vomiting
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