title: Fracture of a GlideScope® Cobalt GVL® Stat disposable blade during an emergency intubation.
abstract: BACKGROUND
  Emergency airway management is a diverse discipline, often utilizing advanced equipment with video technology to enable the intubator to visualize a patient's vocal cords that would be difficult or impossible to see with routine direct laryngoscopy. The GlideScope® Cobalt (Saturn Biomedical Systems, Inc., Burnaby, BC, Canada) is one type of video laryngoscope with disposable plastic GVL® Stat blades (Saturn Biomedical Systems) that can improve glottic view over direct laryngoscopy. It also benefits from rapid turnaround time and few infection control issues due to its disposable blade.
  
  
  OBJECTIVE
  To report what we believe to be the first GlideScope® blade failure to be reported in the medical literature. The circumstances surrounding the blade failure may raise awareness of GVL® Stat usage in obese patients with limited mouth opening.
  
  
  METHODS
  During a standard emergency intubation, insertion of the GVL® Stat into the patient's mouth resulted in breakage of the distal segment of the blade. The patient was severely obese and had limited mouth opening, which required the blade to be inserted obliquely, rather than in the midline, into the patient's mouth. As the handle was repositioned back to midline, the distal segment of the blade broke off. No excessive force was used during blade repositioning when breakage occurred.
  
  
  CONCLUSIONS
  Twisting forces on the distal flat segment of the GVL® Stat may have caused its failure. Because this was only a single occurrence of breakage, it is not clear if design issues or atypical insertion of the blade was responsible for breakage. Care must be exercised when midline insertion is not possible, which can occur in obese patients with limited mouth opening.
authors.affiliation: Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Panacek
authors.forename: Erik G
authors.initials: EG
authors.lastname: Laurin
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Bair
mesh_terms: D004209:Disposable Equipment / Q000592:standards; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes / Q000592:standards*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D014474:Unconsciousness / Q000628:therapy