Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: A Multicenter Study of Clinical Outcomes

• Published in: Annals of emergency medicine Vol. 81; no. 2; pp. 113 - 122
• Main Authors: Miller, Kelsey A., Dechnik, Andzelika, Miller, Andrew F., D'Ambrosi, Gabrielle, Monuteaux, Michael C., Thomas, Phillip M., Kerrey, Benjamin T., Neubrand, Tara, Goldman, Michael P., Prieto, Monica M., Wing, Robyn, Breuer, Ryan, D’Mello, Jenn, Jakubowicz, Andy, Nishisaki, Akira, Nagler, Joshua
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2023
• Subjects: Child; Emergency Service, Hospital; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Prospective Studies
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2022.08.021

To explore the association between video-assisted laryngoscopy (use of a videolaryngoscope regardless of where laryngoscopists direct their gaze), first-attempt success, and adverse airway outcomes.
We conducted an observational study using data from 2 airway consortiums that perform prospective surveillance: the National Emergency Airway Registry for Children (NEAR4KIDS) and a pediatric emergency medicine airway education collaborative. Data collected included patient and procedural characteristics and procedural outcomes. We performed multivariable analyses of the association of video-assisted laryngoscopy with individual patient outcomes and evaluated the association between site-level video-assisted laryngoscopy use and tracheal intubation outcomes.
The study cohort included 1,412 tracheal intubation encounters performed from January 2017 to March 2021 across 11 participating sites. Overall, the first-attempt success was 70.0%. Video-assisted laryngoscopy was associated with increased odds of first-attempt success (odds ratio [OR] 2.01; 95% confidence interval [CI], 1.48 to 2.73) and decreased odds of severe adverse airway outcomes (OR 0.70; 95% CI, 0.58 to 0.85) including decreased severe hypoxia (OR 0.69; 95% CI, 0.55 to 0.87). Sites varied substantially in the use of video-assisted laryngoscopy (range from 12.9% to 97.8%), and sites with high use of video-assisted laryngoscopy (> 80%) experienced increased first-attempt success even after adjusting for individual patient laryngoscope use (OR 2.30; 95% CI, 1.79 to 2.95).
Video-assisted laryngoscopy is associated with increased first-attempt success and fewer adverse airway outcomes for patients intubated in the pediatric emergency department. There is wide variability in the use of video-assisted laryngoscopy, and the high use is associated with increased odds of first-attempt success.