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Background: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques.Methods: Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet.Results: A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period.Conclusions: Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.
CME Credit: 1.00 AMA PRA Category 1 Credit™
Required Hardware / Software:Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.
Activity Release Date:09/20/2016
Activity Expiration Date:09/19/2019
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Learning Objectives: After successfully completing this activity, the learner will be able to:
Faculty and Credentials
Editor-in-Chief: Evan D. Kharasch, M.D., Ph.D., has reported receiving consulting fees from TEN Healthcare and The Medicines Co., and honoraria from Astra-Zeneca.
Editor-in-Chief Emeritus: James C. Eisenach, M.D., receives consulting fees from Aerial BioPharma LLC and Cubist Pharmaceuticals, Inc.
CME Editors: Leslie C. Jameson, M.D. has reported no relevant financial relationships with commercial interests. Dan J. Kopacz, M.D., has an equity position in SoloDex, LLC.
Authors: Michael F. Aziz, M.D., has received research funding and honoraria for speaking from Karl Storz Endoscopy. Ansgar M. Brambrink, M.D., Ph.D., has received research funding from Karl Storz Endoscopy. David W. Healy, M.D., M.R.C.P., F.R.C.A., is a paid scientific advisor to Brio Device LLC. Amy Wen Willett, M.D., Amy Shanks, Ph.D., Tyler Tremper, B.S., Leslie Jameson, M.D., Jacqueline Ragheb, M.B.B.Ch., F.F.A.R.C.S.I., F.J.F.I.C.M.I., Daniel A. Biggs, M.D., William C. Paganelli, M.D., Ph.D., Janavi Rao, M.D., Jerry L. Epps, M.D., Douglas A. Colquhoun, M.B.Ch.B., M.Sc., M.P.H., Patrick Bakke, M.D., and Sachin Kheterpal, M.D., M.B.A., report no relevant financial relationships with commercial interests. Takashi Asai, M.D., Ph.D., reports no relevant financial relationships with commercial interests.
ASA Staff: Kari L. Lee, Editorial Manager, has reported no relevant financial relationships with commercial interests. Ginger Clark, Senior Editor, has an equity position in Merck & Co.
Disclosure StatementThe American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies: Medical knowledge
Target Audience: ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
CME Credit: 1.00 AMA PRA Category 1 Credit™
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 09/20/2016 Activity Expiration Date: 09/19/2019
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