1. Video Laryngoscopy Reduces the Rate of Esophageal Intubations Performed by Emergency Medicine Trainees Parisa P. Javedani, Uwe Stolz, Eric A. Chase, Jessica Garst-Orozco, and John C. Sakles Methods: Retrospective analysis of prospectively collected continuous quality improvement data (CQI) for all tracheal intubations by EM trainees in a level I trauma academic ED over a 6 year period – Data form completed by the EM resident – Analysis included patients in whom intubation was attempted using either a DL or VL (GVL or CMAC) Primary outcome: occurrence of EI Secondary outcome: occurrence of adverse events (AE) Propensity score matching with conditional logistic regression to reduce bias (since device was purposefully chosen by the physician performing the intubation) – DL vs. VL for each intubation attempt with attempts resulting in EI matched randomly to 4 cases without an EI Multivariate logistic regression used to calculate adjusted odds of an EI for VL vs. DL Retrospective analysis of prospectively collected continuous quality improvement data (CQI) for all tracheal intubations by EM trainees in a level I trauma academic ED over a 6 year period – Data form completed by the EM resident – Analysis included patients in whom intubation was attempted using either a DL or VL (GVL or CMAC) Primary outcome: occurrence of EI Secondary outcome: occurrence of adverse events (AE) Propensity score matching with conditional logistic regression to reduce bias (since device was purposefully chosen by the physician performing the intubation) – DL vs. VL for each intubation attempt with attempts resulting in EI matched randomly to 4 cases without an EI Multivariate logistic regression used to calculate adjusted odds of an EI for VL vs. DL Background: Limitations: Single-center study in an academic level I trauma center EM trainees use VL more frequently than DL – Results not generalizable to setting with limited VL experience Number of intubation per individual operator, experience with difficult airways, and experience with each device were varied among each operator Observational, non-randomized data 10% of forms filled out on delayed basis, subject to recall bias May be additional confounder or risk factors for EI contributing to the observed differences that were not accounted for Single-center study in an academic level I trauma center EM trainees use VL more frequently than DL – Results not generalizable to setting with limited VL experience Number of intubation per individual operator, experience with difficult airways, and experience with each device were varied among each operator Observational, non-randomized data 10% of forms filled out on delayed basis, subject to recall bias May be additional confounder or risk factors for EI contributing to the observed differences that were not accounted for Conclusions: Use of VL by EM trainees was associated with a nearly seven-fold reduction in Eis when compared to the use of DL – Magnified view allows for easier identification of the anatomy – Attending physician can visualize on the screen what the operator is seeing, which allows the supervising physician to provide real-time feedback Patients who underwent EI had significantly higher occurrence of AE – Aspiration, dysrhythmia, hypotension, and hypoxemia Use of VL by EM trainees was associated with a nearly seven-fold reduction in Eis when compared to the use of DL – Magnified view allows for easier identification of the anatomy – Attending physician can visualize on the screen what the operator is seeing, which allows the supervising physician to provide real-time feedback Patients who underwent EI had significantly higher occurrence of AE – Aspiration, dysrhythmia, hypotension, and hypoxemia Results: EI n=93 No EI n=2,584 AEn%95% CIn% p-value Aspiration88.63.8 to 16.3361.40.9 to 1.9<0.001 Cardiac Arrest000 to 3.9120.50.2 to 0.81.0 Dysrhythmia33.20.7 to 9.1140.50.3 to 0.90.019 Hypotension22.20.3 to 7.6170.70.4 to 1.10.14 Hypoxemia3335.525.8 to 46.143316.815.3 to 18.3<0.001 Total4649.538.9 to 60.051219.818.3 to 21.4<0.001 Typical DL View Typical VL View GVL CMAC