Airway & Respiratory, Columns, Patient Care

Does EMS Intubation Success Improve with Video Laryngoscopy?

Issue 2 and Volume 42.

Video vs. Direct Larygoscopy

Jarvis JL, McClure SF, Johns D. EMS intubation improves with King Vision video laryngoscopy. Prehosp Emerg Care. 2015;19(4):482–489.

Williamson County EMS, a suburban and rural Texas EMS system, reviewed its endotracheal intubation (ETI) success rates after adding the King Vision video laryngoscope to ALS units.

Considering the county’s suburban and rural settings allow few intubation attempts per provider on an annual basis, researchers believed video laryngoscopy would be advantageous. Overall ETI success rate before the interventions was 64.9%.

Background: The King Vision was chosen both due to provider preference following a cadaver lab session and its relatively low cost. Although previous studies have demonstrated little to no benefit from the addition of video laryngoscopy in services with highly experienced providers and high baseline success rates, the impact of video laryngoscopy hadn’t previously been evaluated in systems where there were a lower number of annual ETI attempts and a low baseline intubation success rate.

Methods: This retrospective, observational study was conducted only in Williamson County. All ETI attempts that were listed on patient charts written between Oct. 1, 2010 and Nov. 14, 2013, were included in the study.

Outcome measures included first-pass success rate, success per attempt, and overall success. For the purpose of this study, an ETI was defined as any time a laryngoscope blade was placed into a patient’s mouth, regardless of if an endotracheal tube was actually passed. Every ETI attempt after Oct. 1, 2012, was required to be conducted via the King Vision.

Several protocol violations were noted during the study period, with patients intubated via direct laryngoscopy rather than video laryngoscopy. These protocol violations prompted the medical director to remove all traditional laryngoscope blades from the medic units outside of a single blade that was to be utilized in the presence of a foreign body airway obstruction.

Results: A total of 514 patients were included in this study, with 185 patients included in the direct laryngoscopy group and 329 patients included in the video laryngoscopy group. The study found an improvement in all three outcome measures that were analyzed in this study following the implementation of the video laryngoscope. Specifically, first-pass success rate improved from 43.8% to 74.2% (p < 0.01), success rate per attempt improved from 44.4% to 71.2% (p < 0.01), and overall success rate improved from 64.9% to 91.5% (p < 0.01).

Conclusion: The authors concluded that video laryngoscopy improved the ETI success rates of the paramedics at this single EMS service. Although not generalizable, this study does pave the way for a randomized, controlled trial comparing these two methods.  

Bottom Line

What we already know: Prehospital endotracheal intubation during cardiac arrest remains controversial.

What this study adds: Video laryngoscopy appears to improve success rates with appropriate training.

prehospital care research forum at UCLA


Prehospital Care Research Forum Posters at EMS Today

The Prehospital Care Research Forum (PCRF) annually presents posters on important research at the 2017 EMS Today Conference in Salt Lake City. The posters will be displayed at the conference and the research will be discussed in two special sessions:

Oral Presentation Luncheon

Thurs., Feb. 23, 12:00–1:30 p.m.

Location: Ballroom I

After a brief overview of PCRF’s annual research program, four of the top abstracts submitted to PCRF will be presented by their authors. (Lunch will be provided to the first 75 people.)

Research Roundtable

Thurs., Feb. 23, 1:45–2:45 p.m.

Location: Ballroom I

In this session, poster presenters will each give a five-minute report on the results of their research. Before the session, please review the posters on display in the lobby so you can discuss the authors’ research.

The Prehospital Care Research Forum can help with designing or conducting research. Visit or send an email to [email protected] for more details.

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