Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults

A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group

Michael Aziz, Ansgar Brambrink, David W. Healy, Amy Wen Willett, Amy Shanks, Tyler Tremper, Leslie Jameson, Jacqueline Ragheb, Daniel A. Biggs, William C. Paganelli, Janavi Rao, Jerry L. Epps, Douglas A. Colquhoun, Patrick Bakke, Sachin Kheterpal

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41 Citations (Scopus)

Abstract

BACKGROUND:: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. METHODS:: Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. RESULTS:: A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. CONCLUSIONS:: Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

Original languageEnglish (US)
JournalAnesthesiology
DOIs
StateAccepted/In press - Aug 1 2016

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Laryngoscopy
Intubation
Anesthesia
Databases

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults : A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group. / Aziz, Michael; Brambrink, Ansgar; Healy, David W.; Willett, Amy Wen; Shanks, Amy; Tremper, Tyler; Jameson, Leslie; Ragheb, Jacqueline; Biggs, Daniel A.; Paganelli, William C.; Rao, Janavi; Epps, Jerry L.; Colquhoun, Douglas A.; Bakke, Patrick; Kheterpal, Sachin.

In: Anesthesiology, 01.08.2016.

Research output: Contribution to journalArticle

Aziz, M, Brambrink, A, Healy, DW, Willett, AW, Shanks, A, Tremper, T, Jameson, L, Ragheb, J, Biggs, DA, Paganelli, WC, Rao, J, Epps, JL, Colquhoun, DA, Bakke, P & Kheterpal, S 2016, 'Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group', Anesthesiology. https://doi.org/10.1097/ALN.0000000000001267
Aziz, Michael ; Brambrink, Ansgar ; Healy, David W. ; Willett, Amy Wen ; Shanks, Amy ; Tremper, Tyler ; Jameson, Leslie ; Ragheb, Jacqueline ; Biggs, Daniel A. ; Paganelli, William C. ; Rao, Janavi ; Epps, Jerry L. ; Colquhoun, Douglas A. ; Bakke, Patrick ; Kheterpal, Sachin. / Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults : A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group. In: Anesthesiology. 2016.
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abstract = "BACKGROUND:: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. METHODS:: Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. RESULTS:: A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92{\%}; 95{\%} CI, 90 to 93) than other techniques: supraglottic airway conduit (78{\%}; 95{\%} CI, 68 to 86), flexible bronchoscopic intubation (78{\%}; 95{\%} CI, 71 to 83), lighted stylet (77{\%}; 95{\%} CI, 69 to 83), and optical stylet (67{\%}; 95{\%} CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69{\%}), and its use has increased during the study period. CONCLUSIONS:: Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.",
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T2 - A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group

AU - Aziz, Michael

AU - Brambrink, Ansgar

AU - Healy, David W.

AU - Willett, Amy Wen

AU - Shanks, Amy

AU - Tremper, Tyler

AU - Jameson, Leslie

AU - Ragheb, Jacqueline

AU - Biggs, Daniel A.

AU - Paganelli, William C.

AU - Rao, Janavi

AU - Epps, Jerry L.

AU - Colquhoun, Douglas A.

AU - Bakke, Patrick

AU - Kheterpal, Sachin

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N2 - BACKGROUND:: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. METHODS:: Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. RESULTS:: A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. CONCLUSIONS:: Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

AB - BACKGROUND:: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. METHODS:: Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. RESULTS:: A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. CONCLUSIONS:: Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

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