Kinkle WC , Levitan RM, Levin W. The Glidescope Video Laryngoscope

In The Hands of Novice Users: Seeing The Larynx Does Not Correlate

With Intubation Success [Abstract]. Ann Emerg Med. 2004; 44: S 119.

The Glidescope Video Laryngoscope In The Hands of

Novice Users: Seeing The Larynx Does Not Correlate

With Intubation Success

Objectives

Inherent ease of use and initial skill acquisition are major

considerations for selecting rescue intubation devices.  The

Glidescope Video Laryngoscope (GVL, Saturn Biomedical) uses a camera

built within the curve of a laryngoscope. The camera position and

wide field of view create laryngeal visualization via a monitor in

almost any patient, regardless of anatomic features associated with

difficult laryngoscopy.  Because of it's traditional laryngoscope

shape and method of insertion the GVL is expected to be easy to use

with fast initial skill acquisition. The objective of this study was

to assess the intubation performance of novice users of the GVL.

Methods

16 participants (11 EM physicians, 4 residents, 1 P.A.) in an airway

workshop tried the GVL on 3 randomly ordered, non-embalmed cadavers.

Participants observed 1 demonstration and were told to shape the

tube  stylet as recommended by the manufacturer. Each attempt was

recorded using a digital VCR connected to the GVL monitor. Success was

defined as tracheal intubation; failure defined by the operator giving up or

by unrecognized esophageal placement.

Results

Laryngeal view was excellent in all cases. Overall, 36/48 (75%)

attempts succeeded; mean intubation time 76 seconds (95% CI 58-94).

7/36 successful intubations occurred in 30 seconds or less. 9/16

participants succeeded on all 3 cadavers; 1 failed on all 3. 

Success by cadaver varied from 15/16 (best) to 10/16 (worst), with mean

success times per cadaver from 48s (95% CI 31-65) (best) to 108s (95%

CI 73-143) (worst).   Performance was not related to the order of

attempts: first cadaver attempt success rate was 13/16 (mean time

86s+/- 31) vs. third cadaver success rate of 10/16 (mean time 74s

+/- 38).

Conclusions

GVL intubation-via a monitor and procedurally similar to laparoscopic

surgery-- is time consuming, awkward and often unsuccessful for

novice users.  GVL difficulty varied considerably between cadavers.

3 attempts did not produce competency in our study.