title: EMS Intubation Improves with King Vision Video Laryngoscopy.
abstract: BACKGROUND
  Intubation success by paramedics has historically been variable. The lack of first-pass success (FPS) has been associated with increased adverse events. Various video laryngoscope (VL) devices have been investigated to improve success among paramedics. Conflicting research exists on VL vs. direct laryngoscopy (DL) by paramedics and on the effects of the specific King Vision device on FPS and overall success (OS) in an emergency medical services (EMS) system with low intubation frequency and historically low success rates.
  
  
  OBJECTIVE
  To evaluate the effect of an ongoing training program using the King Vision VL on FPS, OS, and success per attempt when compared with DL in one suburban EMS system with low historical intubation success rates.
  
  
  METHODS
  We performed a retrospective analysis of electronic patient care reports in a suburban EMS system. We analyzed three metrics of intubation success before DL and after implementation of ongoing training with VL in both cardiac arrest and in all other indications: success per attempt, overall success, and first-pass success. We also performed an intention to treat analysis of these rates to account for protocol violations.
  
  
  RESULTS
  During the study period, intubation was attempted on 514 patients. There was no difference between the DL and VL groups in age, weight, gender, or percentage receiving paralytic medications. There was improvement over DL with VL in each of the outcome measures: overall success (64.9 vs. 91.5%, p < 0.01), first-pass success (43.8% vs. 74.2%, p < 0.01), and success per attempt (44.4 vs. 71.2%, p < 0.01). A subgroup analysis by indication for intubation also showed improvement in all metrics for all indications. There were several protocol violations: 11 of 376 attempts that should have used VL (2.9%) but were done with DL. An intention to treat analysis was therefore done. Again, we saw an improvement in all metrics for all indications.
  
  
  CONCLUSIONS
  In this suburban EMS system with historically low intubation success rates and low frequency of intubation, paramedics were able to improve all measures of intubation success using the King Vision video laryngoscope and an ongoing training program when compared with direct laryngoscopy.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jarvis
authors.forename: Sarah Frances
authors.initials: SF
authors.lastname: McClure
authors.forename: Danny
authors.initials: D
authors.lastname: Johns
mesh_terms: D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000193:education* / Q000379:methods; D008297:Male; D008348:Manikins; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D014741:Video Recording