title: Intubation Performance of Advanced Airway Devices in a Helicopter Emergency Medical Service Setting.
abstract: OBJECTIVE
  This study attempts to determine if newer indirect laryngoscopes or intubating devices are superior to a standard laryngoscope for intubation success among helicopter emergency medical service (HEMS) personnel.
  
  
  METHODS
  Flight nurses and paramedics intubated standardized mannequins with a normal airway, a trauma airway, and a difficult airway using a standard laryngoscope, a gum elastic bougie, the Airtraq laryngoscope (King System Corp, Noblesville, IN), the Glidescope Ranger laryngoscope (Verathon Inc, Bothell, WA), and the S.A.L.T. device (Microtek Medical, Inc, Lehmberg, IN) in grounded helicopters wearing helmets and flight gear. Participant demographics, time to glottic view, the modified Cormack-Lehane score, total intubation time, number of attempts, and overall successful intubation were recorded for each type of airway.
  
  
  RESULTS
  Two-hundred thirty-six subjects were initially enrolled across 107 bases in 15 states, and 177 completed the study. First-attempt success rates did not vary by device for the normal airway (P = .203), but the Airtraq laryngoscope and the S.A.L.T. device were highest in the difficult airway (82.0% and 85.0%, respectively; P < .0001). The time to first-attempt success in the difficult airway was lowest for the S.A.L.T. device and the Airtraq laryngoscope (mean = 9.72 seconds and 19.70 seconds, respectively; P < .0001).
  
  
  CONCLUSIONS
  Using HEMS providers, the Airtraq laryngoscope and the S.A.L.T. device showed the fastest and highest intubation success on the first attempt in difficult simulated HEMS airway scenarios.
authors.affiliation: University of Illinois College of Medicine at Peoria, Peoria, IL, USA; Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA. Electronic address: jhafner@uic.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Hafner
authors.affiliation: Department of Anesthesiology, University of Chicago, Chicago, IL, USA.
authors.forename: Blake W
authors.initials: BW
authors.lastname: Perkins
authors.affiliation: Department of Emergency Medicine, Mercy Clinic, Springfield, MO, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Korosac
authors.affiliation: University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors.forename: Alayna K
authors.initials: AK
authors.lastname: Bucher
authors.affiliation: University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Aldag
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA; Air Evac Lifeteam, Air-Evac, Inc, O'Fallon, MO, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Cox
mesh_terms: D000328:Adult; D017732:Air Ambulances; D058109:Airway Management / Q000295:instrumentation / Q000379:methods; D018592:Cross-Over Studies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged