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gum-elastic bougie, or switching operators. Results were entered into a REDCap (Research Electronic Data Capture) database for analysis.
RESULTS
A total of 135 patients were enrolled during the study period. The patient population consisted of 74 medical and 61
was 74.1% (100/135). Of these intubations, 131 out of 135 intubations were initially performed with video laryngoscopy via CMAC (97%). Of these, the CMAC was used as a direct laryngoscopy device in 23 patients.
First-pass intubation success was achieved in 100 (74.1%) of attempted intubations. Of the recorded intubations, PGY-1
3 or equivalent 57 (42%), EM Attending nine (6.67%), and attempt was performed with a C-MAC in 34 of 35 cases (97.1%). Direct laryngoscopy was used for a subsequent attempt once (2.8%). A gum-elastic bougie was utilized most frequently as a rescue adjunct, in 19 of these cases (55.9%).
DISCUSSION
Airway management mastery is an essential core curriculum objective taught in every EM residency. Since the inception of the specialty, this critical skillset has primarily been obtained via the practice of DL. Within the past 10 years, VL
CONTRIBUTING AUTHORS
has become more widespread and available and appears to be replacing DL as the primary device of choice for intubations at this and many other large academic emergency departments.
as an initial intubating device among all health care professionals at our large academic EM residency. First-pass success rates were typical for values reported in the current literature regarding EM airway management as well.2-4,8,10 Importantly though, this study highlighted the repeat use of VL as the most common rescue technique after a failed initial intubation, while DL was only used once as a rescue technique after a failed initial attempt.
VL is certainly a cutting-edge technological advance in airway management, but is not without its pitfalls. Video devices are expensive and are not ubiquitous in all EDs throughout the United States. Airways with copious secretions or blood can obscure the camera, rendering the device essentially inoperable. Wilderness, prehospital, or rural locations may not allow for sensitive, expensive equipment at all times. DL, therefore, remains an essential skill and should be emphasized in the training of the EM resident.
CONCLUSION
primary modality for intubation in our large academic emergency department. DL, once the mainstay of practice, is no longer
used primarily or as a rescue technique. Our results indicate a need to examine current educational methods regarding airway management and to determine whether we should rethink our strategy of VL for the initial method in learners. Additional training, with an emphasis on the utilization of multiple modalities, may be required to help EM residents master the
■ STEPHEN SENICHKA, DO is a Hospitalist with Christiana Care Hospitalist Partners (CCHP) and an Emergency Physician with Doctors for Emergency Services (DFES) within the Christiana Care Health System.
■ STEPHEN KOCZIRKA, MD is board-certified in emergency medicine and practices as academic faculty with DFES in the Christiana Care Health System. ■ DEB MARCO, RN, BSN, CCRC is an EM Clinical Research Nurse within Christiana Care Health System’s Department of Emergency Medicine.
■ BRETT SCHUCHARDT, MS is a Research Assistant within Christiana Care Health System’s Department of Emergency Medicine.
■ REBECCA KOWALSKI is a Research Assistant within Christiana Care Health System’s Department of Emergency Medicine.
■ BARBARA DAVIS, RN is an EM Clinical Research Nurse within Christiana Care Health System’s Department of Emergency Medicine.
■ BRIAN LEVINE, MD is the Associate Chief Academic Officer at Christiana Care Health Systems, formerly Program Director.
■ RYAN ARNOLD, MD is an Emergency Medicine Physician and Clinical Researcher in the Department of Emergency Medicine at Drexel University in Philadelphia.
84 Del Med J | March/April 2019 | Vol. 91 | No. 2
