title: A comparison of plastic single-use with metallic reusable laryngoscope blades for out-of-hospital tracheal intubation.
abstract: OBJECTIVE
  The objective of this study was to compare, in the emergency out-of-hospital environment, intubation success rates during the first laryngoscopy for 2 laryngoscope blade types: a metallic reusable and a plastic single-use.
  
  
  METHODS
  An observational before-and-after study was conducted during 2 1-year periods. Adult patients were intubated by emergency physicians, anesthesiologists, or anesthesia nurses in the out-of-hospital setting with metallic reusable (first period) or a plastic disposable (second period) Macintosh 3 or 4 laryngoscope blades. Immediately after intubation, data were collected on success rate of intubation at the first attempt, intubation difficulty score, quality of laryngeal visualization, and the need for alternative airway techniques. To compare the 2 periods of the study, Wilcoxon's test was used for quantitative variables, and the chi2 or Fisher's exact test was used for qualitative variables.
  
  
  RESULTS
  Patients intubated with a metallic blade (594/1,177; 50.5%) and with a plastic blade (583/1,177; 49.5%) were included in the study. The first-attempt intubation success rate was higher in the metallic blade group (497/594, 84%) than in the single-use group (76%); difference 7% (95% confidence interval [CI] 3% to 12%) (P<.002). The incidence of difficult intubation, defined by an intubation difficulty score greater than 5, was lower (6% [95% CI 4% to 8%] versus 15% [95% CI 12% to 18%]) when metallic blades were used. A good laryngeal view (Cormack and Lehane classes I and II) was more frequently observed with metallic blade use (83% [95% CI 80% to 86%] versus 67% [95% CI 64% to 70%]). Alternative airway techniques such as the use of a Gum elastic bougie or an intubating laryngeal mask airway were more frequently used in the plastic blade period (12% [95% CI 10% to 14%] versus 4% [95% CI 2% to 6%]).
  
  
  CONCLUSIONS
  In out-of-hospital emergency care, the use of a plastic disposable laryngoscope blade decreased the success rate of tracheal intubation at the first attempt performed by emergency care providers.
authors.affiliation: Department of Emergency Medicine, Service d'Urgence et de Réanimation 94, Créteil, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jabre
authors.forename: Bertrand
authors.initials: B
authors.lastname: Leroux
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Brohon
authors.forename: Candice
authors.initials: C
authors.lastname: Penet
authors.forename: David
authors.initials: D
authors.lastname: Lockey
authors.forename: Frederic
authors.initials: F
authors.lastname: Adnet
authors.forename: Alain
authors.initials: A
authors.lastname: Margenet
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
authors.forename: Xavier
authors.initials: X
authors.lastname: Combes
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004209:Disposable Equipment; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D010969:Plastics; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D010969:Plastics