Russo Sebastian G, Nickel Eike A, Leissner Kay B, Schwerdtfeger Katrin, Bauer Martin, Roessler Markus S
Department of Anaesthesiology, University Hospital Göttingen, 370799, Göttingen, Germany.
Current address: Department of Anaesthesiology and Pain Medicine, HELIOS Klinikum Emil-von-Behring, Berlin, Germany.
BMC Emerg Med. 2016 Jan 29;16:8. doi: 10.1186/s12873-016-0069-2.
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.
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.
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.
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.
院前气管插管比在手术室中更困难。因此，诸如视频喉镜等增强气道管理设备可能有助于提高院前插管成功率。我们描述了使用Glidescope®-Ranger（GS-R）作为负责的急诊医生（EP）酌情使用的替代气道工具。
在3.5年期间，GS-R可供接受过麻醉培训、使用成角度视频喉镜经验有限的EP用于院前插管的主要或备用工具。
在此期间，672例患者需要院前插管，其中56例使用了GS-R。GS-R的总体成功率为66%（EP之间的范围为34%-100%）。困难或失败的原因包括EP对GS-R缺乏经验、因分泌物、呕吐物、血液导致视野受损，或在非常明亮的环境中由于阳光无法看到屏幕。
在院前环境中，使用GS-R成功完成气管插管需要特殊的专业知识和大量培训。对直接喉镜检查以及视频辅助插管缺乏经验的提供者不应期望仅仅因为有视频喉镜就能够轻松进行气管插管。此外，由于血液、分泌物或明亮阳光等阻碍情况，在院前环境中间接喉镜检查可能困难甚至无法实现。因此，视频喉镜，在此为GS-R，无论是对专家还是对缺乏经验的提供者，都不应被视为气管插管的“圣杯”。
