title: Use of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial.
abstract: OBJECTIVE
  We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting.
  
  
  METHODS
  Multicenter, prospective, randomized, control trial with patient recruitment over 18 months.
  
  
  METHODS
  Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway.
  
  
  METHODS
  Adult emergency patients requiring endotracheal intubation.
  
  
  METHODS
  Airway management strictly following a prehospital algorithm. First and second intubation attempt employing GlideScope or direct laryngoscopy as randomized; third attempt crossover. After three failed intubation attempts, immediate use of an extraglottic airway device.
  
  
  RESULTS
  A total of 326 patients were enrolled. Success rate with the GlideScope (n = 168) versus direct laryngoscopy (n = 158) group was 61.9% (104/168) versus 96.2% (152/158), respectively (p < 0.001). The main reasons for failed GlideScope intubation were failure to advance the tube into the larynx or trachea (26/168 vs 0/158; p < 0.001) and/or impaired sight due to blood or fluids (21/168 vs 3/158; p < 0.001). When GlideScope intubation failed, direct laryngoscopy was successful in 61 of 64 patients (95.3%), whereas GlideScope enabled intubation in four of six cases (66.7%) where direct laryngoscopy failed (p = 0.055). In addition, GlideScope was prone to impaired visualization of the monitor because of ambient light (29/168; 17.3%). There was no correlation between success rates and body mass index, age, indication for airway management, or experience of the physicians, respectively.
  
  
  CONCLUSIONS
  Video laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.
authors.affiliation: 1Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital, Wiener Neustadt, Austria. 2ÖAMTC Austrian Air Rescue, Vienna, Austria. 3Department of Anesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria. 4Department of Anesthesiology, Mistelbach General Hospital, Mistelbach, Austria. 5Norwegian Air Ambulance, Ålesund, Norway. 6Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Center, Salzburg, Austria. 7AUVA Trauma Center Salzburg, Paracelsus Private Medical University of Salzburg, Salzburg, Austria. 8Department of Health Studies, University of Stavanger, Stavanger, Norway.
authors.forename: Helmut
authors.initials: H
authors.lastname: Trimmel
authors.forename: Janett
authors.initials: J
authors.lastname: Kreutziger
authors.forename: Robert
authors.initials: R
authors.lastname: Fitzka
authors.forename: Stephan
authors.initials: S
authors.lastname: Szüts
authors.forename: Christoph
authors.initials: C
authors.lastname: Derdak
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Koch
authors.forename: Boris
authors.initials: B
authors.lastname: Erwied
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Voelckel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004632:Emergency Medical Services; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014741:Video Recording; D055815:Young Adult