title: Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians - an observational study.
abstract: BACKGROUND
  Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge.
  
  
  METHODS
  During a 3.5 year period, the GS-R was available to be used either as the primary or backup tool for pre-hospital intubation by anaesthesia trained EP with limited expertise using angulated videolaryngoscopes.
  
  
  RESULTS
  During this period 672 patients needed pre-hospital intubation of which the GS-R was used in 56 cases. The overall GS-R success rate was 66 % (range of 34-100 % among EP). The reasons for difficulties or failure included inexperience of the EP with the GS-R, impaired view due to secretion, vomitus, blood or the inability to see the screen in very bright environment due to sunlight.
  
  
  CONCLUSIONS
  Special expertise and substantial training is needed to successfully accomplish tracheal intubation with the GS-R in the pre-hospital setting. Providers inexperienced with DL as well as video-assisted intubation should not expect to be able to perform tracheal intubation easily just because a videolaryngoscope is available. Additionally, indirect laryngoscopy might be difficult or even impossible to achieve in the pre-hospital setting due to impeding circumstances such as blood, secretions or bright sun-light. Therefore, videolaryngoscopes, here the GS-R, should not be considered as the "Holy Grail" of endotracheal intubation, neither for the experts nor for inexperienced providers.
authors.affiliation: Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany. s.russo@medizin.uni-goettingen.de.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.affiliation: Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany.|Current address: Department of Anaesthesiology and Pain Medicine, HELIOS Klinikum Emil-von-Behring, Berlin, Germany.
authors.forename: Eike A
authors.initials: EA
authors.lastname: Nickel
authors.affiliation: Department of Anesthesiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
authors.forename: Kay B
authors.initials: KB
authors.lastname: Leissner
authors.affiliation: Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany.
authors.forename: Markus S
authors.initials: MS
authors.lastname: Roessler
mesh_terms: D058109:Airway Management; D000776:Anesthesiology / Q000193:education; D004636:Emergency Service, Hospital; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital; D013647:Task Performance and Analysis; D014741:Video Recording
references.citation: J Anesth. 2009;23(3):445-8
references.pmid: 19685133
references.citation: Resuscitation. 2014 May;85(5):617-22
references.pmid: 24561079
references.citation: Emerg Med J. 2011 Aug;28(8):650-3
references.pmid: 21422034
references.citation: Prehosp Emerg Care. 2010 Apr-Jun;14(2):278-82
references.pmid: 20199237
references.citation: Anaesthesist. 2010 Oct;59(10):929-39
references.pmid: 20827450
references.citation: Resuscitation. 2010 Oct;81(10):1305-52
references.pmid: 20956049
references.citation: J Trauma. 2003 Oct;55(4):713-9
references.pmid: 14566128
references.citation: Br J Anaesth. 2006 Jan;96(1):67-71
references.pmid: 16311285
references.citation: J Clin Anesth. 2006 Aug;18(5):357-62
references.pmid: 16905081
references.citation: Resuscitation. 2006 Aug;70(2):179-85
references.pmid: 16828956
references.citation: Anesth Analg. 2007 Mar;104(3):619-23
references.pmid: 17312220
references.citation: Br J Anaesth. 2007 Aug;99(2):286-91
references.pmid: 17584849
references.citation: Anesthesiology. 2007 Oct;107(4):570-6
references.pmid: 17893452
references.citation: Curr Opin Anaesthesiol. 2007 Dec;20(6):595-9
references.pmid: 17989557
references.citation: Anesthesiology. 2009 Jan;110(1):32-7
references.pmid: 19104167
references.citation: Resuscitation. 2009 Aug;80(8):888-92
references.pmid: 19520484
references.citation: Eur J Emerg Med. 2011 Oct;18(5):282-4
references.pmid: 21430543
references.citation: Can J Anaesth. 2012 Jan;59(1):41-52
references.pmid: 22042705
references.citation: J Clin Anesth. 2012 Nov;24(7):593-7
references.pmid: 23101777
references.citation: Scand J Trauma Resusc Emerg Med. 2013;21:58
references.pmid: 23883447
references.citation: Emerg Med J. 2014 Jan;31(1):65-8
references.pmid: 23345316
references.citation: Anaesthesia. 2009 Nov;64(11):1207-10
references.pmid: 19825056