title: Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding.
abstract: BACKGROUND
  Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII).
  
  
  METHODS
  We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was "GI bleed" were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate.
  
  
  RESULTS
  We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15].
  
  
  CONCLUSIONS
  In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.
authors.affiliation: Saint Vincent Hospital, Department of Emergency Medicine, Erie, Pennsylvania.
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
authors.affiliation: Saint Vincent Hospital, Department of Emergency Medicine, Erie, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Crofts
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Ron M
authors.initials: RM
authors.lastname: Walls
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014741:Video Recording