(1057) Video Killed the DL Star? Analysis of Videolaryngoscopy in the Emergency Department

Introduction: The use of technology to improve provider success during intubation has resulted in a higher utilization of Hyperangulated Video Laryngoscopy (VL) in the Emergency Department (ED). The use of VL in a teaching environment allows for real-time feedback to new learners, and also provides an opportunity for education and improvement of provider technique during this common ED procedure. The goal of this study was to review the technique of our providers during VL intubation to assess areas of improvement that can be discussed in an educational setting.

Methods: 54 intubations performed using hyperangulated video laryngoscopy at a single academic hospital were recorded and reviewed. All intubations included in the study were performed by Emergency Medicine resident physicians under the direct supervision of attending physicians. Review of the collected videos was performed by a minimum of two persons and discrepancies were resolved by consensus discussion. Variables that were included in this review of VL in the ED included blade placement, suction use, and instances of posterior oropharynx bleeding that occurred throughout the procedure.

Results: Of 54 total intubations, approximately 52% occurred with optimal blade placement, while 48% of the time blade placement was either too deep (22.2%), too shallow (18.5%), or too far to one side (Left 7.4%, Right 7.4%). Blade misplacement in multiple directions occurred in 7.4% attempts. Suction use as an adjunct during VL occurred in 20% of intubation attempts, and was not used in 79% of cases. Unnecessary suction use during VL occurred 54.5% (6/11) of the time suction was used. Based on reviewer consensus, suction did not occur in 14.0% (6/43) of total cases where suction was needed. Instances of posterior oropharyngeal trauma occurred in 7.4% attempts.

Conclusions: This study showed that correct blade placement and the use of suction are both areas that can be addressed during education for novice intubators. Almost half of all endotracheal intubations had an error in blade placement with the most common mistake being deep placement and over half of the uses of suction were deemed unnecessary by the reviewers. Posterior oropharyngeal trauma was not a large area of error for our residents.