Driver Brian E, Prekker Matthew E, Moore Johanna C, Schick Alexandra L, Reardon Robert F, Miner James R
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Division of Pulmonary/Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
Acad Emerg Med. 2016 Apr;23(4):433-9. doi: 10.1111/acem.12933. Epub 2016 Mar 24.
Direct laryngoscopy (DL) has long been the most common approach for emergency endotracheal intubation, although the use of video laryngoscopy (VL) is becoming more widespread. Current observational data suggest that VL has higher first-pass success, although randomized trials are lacking.
The objective was to compare first-pass success in patients undergoing emergency intubation with DL or VL using a C-MAC device.
This was an open-label, prospective, randomized, controlled trial in an academic emergency department of patients undergoing emergency intubation with a plan of DL for the first attempt. Patients were randomly assigned in a 1:1 ratio to either DL or VL using a C-MAC device for the first intubation attempt. The primary outcome was first-pass success. Secondary outcomes included time to intubation, development of aspiration pneumonia, and hospital length of stay (LOS). The study was registered at Clinicaltrials.gov, number NCT01710891.
A total of 198 patients were enrolled and intubated with either DL (n = 95) or VL (n = 103). First-attempt success was 86 and 92% for the DL and VL groups, respectively (difference = -5.9%, 95% confidence interval = -14.5% to 2.7%, p = 0.18). Time to intubation, rates of aspiration pneumonia, and hospital LOS were not different between the two groups.
In patients undergoing emergency intubation in whom DL was planned for the first attempt, we did not detect a difference between VL or DL using the C-MAC device in first-pass success, duration of intubation attempt, aspiration pneumonia, or hospital LOS.
直接喉镜检查（DL）长期以来一直是紧急气管插管最常用的方法，尽管视频喉镜检查（VL）的使用越来越广泛。目前的观察数据表明，VL的首次插管成功率更高，尽管缺乏随机试验。
目的是比较使用C-MAC设备进行紧急插管的患者中，DL或VL的首次插管成功率。
这是一项在学术急诊科进行的开放标签、前瞻性、随机对照试验，对象是计划首次尝试进行DL的紧急插管患者。患者以1:1的比例随机分配，首次插管尝试时使用C-MAC设备进行DL或VL。主要结局是首次插管成功。次要结局包括插管时间、吸入性肺炎的发生情况以及住院时间（LOS）。该研究已在Clinicaltrials.gov注册，注册号为NCT01710891。
共纳入198例患者，分别进行了DL（n = 95）或VL（n = 103）插管。DL组和VL组的首次尝试成功率分别为86%和92%（差异=-5.9%，95%置信区间=-14.5%至2.7%，p = 0.18）。两组之间的插管时间、吸入性肺炎发生率和住院LOS没有差异。
在计划首次尝试进行DL的紧急插管患者中，我们未发现使用C-MAC设备进行VL或DL在首次插管成功率、插管尝试持续时间、吸入性肺炎或住院LOS方面存在差异。
