title: Comparison of video laryngoscopy and direct laryngoscopy in a critical care transport service.
abstract: OBJECTIVE
  We evaluated video laryngoscopy (VL) (C-MAC, Karl Storz, Tuttlingen, Germany) for use in a critical care transport system. We hypothesized that the total number of airway attempts would decrease when using a video laryngoscope versus use of direct laryngoscopy (DL).
  
  
  METHODS
  We performed a nonrandomized group-controlled trial where six aircraft were outfitted with VL and the remainder utilized DL responding to a mix of scene runs and interfacility transports. Our primary outcome measure was the number of intubation attempts. We also compared the first-pass success (FPS) rates, laryngoscopic grades, and frequencies of rescue device use (including utilization of surgical airways) between VL and DL.
  
  
  RESULTS
  Crews intubated 348 patients with VL and 510 with DL. Successful endotracheal intubation within three attempts occurred 97.6% (confidence interval [CI] 96.5-98.6) of the time. The FPS rate was 85.8% (CI 83.4-88.1). In this cohort of patients, VL did not differ from DL with respect to total number of airway attempts (1.17 [CI 1.11-1.22] vs. 1.16 [CI 1.12-1.20]), FPS rate (85.6% [CI 82-89%] vs. 86.1% [CI 83-89]), or use of rescue airways (2.6% vs. 2.2%). The laryngoscopic view was superior in the VL group relative to the DL group (median Cormack-Lehane grade 1 [interquartile range (IQR) 1, 2] vs. 2 [IQR 1, 2]).
  
  
  CONCLUSIONS
  VL using the C-MAC video laryngoscope did not reduce the total number of airway attempts or improve intubation compared with DL in a system of highly trained providers.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. fguyette@statmedevac.com
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Kathryn
authors.initials: K
authors.lastname: Farrell
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Paul
authors.initials: P
authors.lastname: Phrampus
mesh_terms: D000328:Adult; D017732:Air Ambulances; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D014741:Video Recording