title: Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians.
abstract: OBJECTIVE
  To compare the first-attempt success in endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) using direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope(®)) among novice emergency physicians (EPs).
  
  
  METHODS
  This study is a historically controlled clinical design. From May 2011 to April 2013 out-of-hospital cardiac arrest patients were intubated during CPR by novice EPs. CPR data was automatically recorded by pre-installed video and subsequently analysed. The primary outcome was the success rate of the first-attempt at ETI. In addition, time to successful ETI from first-attempt (T-complete), duration of chest compression interruptions, and incidence of oesophageal intubation were compared.
  
  
  RESULTS
  Of 305 patients undergoing ETI, 83 were intubated by novice EPs. The success rate of first-attempt ETI in the VL group (n=49) was higher than that in the DL group (n=34, 91.8% vs. 55.9%; p<0.001). The median T-complete was significantly shorter with VL than with DL (37 [29-55] vs. 62 [56-110] s; p<0.001). Oesophageal intubation was observed only in the DL group (n=6, 17.6%). The median duration of chest compression interruptions was greater with DL (7 [3-6] s) than with VL (0 [0-0] s). Improvements in ETI during CPR were observed in the VL group after the first 3 months, but not the DL group during regular use for 1 year.
  
  
  CONCLUSIONS
  For novice EPs, the VL could significantly improve the first-attempt success in ETI during CPR while the DL couldn't improve it.
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea. Electronic address: empso@kuh.ac.kr.
authors.forename: Sang O
authors.initials: SO
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Na
authors.affiliation: Department of Emergency Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Kyeong Ryong
authors.initials: KR
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Kwang Je
authors.initials: KJ
authors.lastname: Baek
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D065386:Historically Controlled Study; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020535:Video-Assisted Surgery
keywords: Cardiopulmonary resuscitation; Endotracheal intubation; High frequency chest compression; Interruption; Video laryngoscopy