Video laryngoscopy versus direct laryngoscopy for tracheal intubation during in-hospital cardiopulmonary resuscitation.

Abstract

Tracheal intubation during cardiopulmonary resuscitation (CPR) is a high-risk procedure. Here, we investigated the efficacy of video laryngoscopy for tracheal intubation during CPR. Data regarding tracheal intubation during CPR from in-hospital cardiac arrests occurring between January 2011 and December 2013 (n=229) were prospectively collected and retrospectively analyzed. The initial laryngoscopy method was video laryngoscopy in 121 patients (52.8%) and direct laryngoscopy in 108 patients (47.2%). The rate of successful intubation at the first attempt was higher with video laryngoscopy (71.9%; 87/121) than with direct laryngoscopy (52.8%; 57/108; p=0.003). The rate of success at the first attempt was higher for experienced (73.0%; 84/115) than inexperienced operators, including residents (52.6%; 60/114; p=0.001). Mortality at day 28 after CPR was not significantly different between patients with successful tracheal intubation at the first attempt and without (68.1% [98/144] vs. 67.1% [57/85]; p=0.876). In multivariate logistic regression analysis, a predicted difficult airway (odds ratio [95% confidence interval]=0.22 [0.10-0.49]; p<0.001), intubation by an experienced operator (2.63 [1.42-4.87]; p=0.002), and use of video laryngoscopy rather than direct laryngoscopy (2.42 [1.30-4.45]; p=0.005) were independently associated with a successful tracheal intubation at the first attempt. Use of video laryngoscopy during CPR from in-hospital cardiac arrest is independently associated with successful tracheal intubation at the first attempt.