Video Analysis of Prehospital Emergency Intubations

Study Overview
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Brief Summary
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The Investigators' knowledge about pre-hospital emergency intubations is still limited. Various factors such as the average and the normal range of intubation time are still unknown. Since its launch Rega videotapes all intubation attempts with the C-MAC videolaryngoscope. The investigators prospectively analysed all routinely recorded intubation videos during one year performed by the Rega crews. The investigators analysed different parameters such as first pass success rate and the time to successfully intubate alongside with others. The goal was to find out more about this difficult procedure, about the problems which regularly occur and on what should be put particular emphasis during training.

Detailed Description
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Pre-hospital emergency intubations are especially hazardous. The incidence of unanticipated difficult airways is higher (9,3 % of prehospital intubations are more difficult than anticipated). The first attempt intubation success rates are lower and the rate of complications compared to in-hospital emergency intubations is higher. There is conflicting evidence if first attempt intubation success rate in prehospital intubations differs between intubations performed by videolaryngoscopy and direct laryngoscopy. On the other hand in pre-hospital airway management, the use of a C-MAC videolaryngoscope improved the visualization of glottic structures significantly. The C-MAC has recently launched a new version, which allows videotaping of intubations. Rega decided to videotape all intubation attempts for legal purposes and quality control. These videos are stored at a Rega-based secure central database. The Investigators knowledge there is only one video-enhanced retrospective analyses of a limited number of videolaryngoscopic pre-hospital intubations. So far, there is no video-enhanced prospective analysis of first attempt intubation success rates or of the time necessary for successful intubation with videolaryngoscopes in the pre-hospital setting available. Therefore, the investigators intend to determine the exact first attempt intubation success rate and the time necessary to successfully intubate, alongside with parameters such as the Cormack/Lehane grade, blade position (Macintosh vs Miller) and others (e.g. difficulties during intubation) in the pre-hospital physician-staffed HEMS-setting. The investigators' goal is to learn more about what is actually happening during prehospital intubations and what type of difficulties may occur. The investigators therefore prospectively analysed all routinely recorded intubation videos (using the built-in camera of the C-MAC videolaryngoscope) during one year performed by the Rega crews. These videos show real life intubations through the video function included in the device, only the image from the tip of the laryngoscopy blade inside the patient's mouth is recorded. The operating physicians additionally provided anonymous information about intubation management for each video after returning to the helicopter base

Official Title
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Evaluation of Prehospital Emergency Intubations Using Videolaryngoscopes

Conditions
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Intubation, Prehospital, Videolaryngoscopy

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • All videos routinely taken from intubations performed during 1 year at the Swiss Air Rescue (Rega) at all 13 helicopter bases Exclusion Criteria: Patients who were intubated primarily using other devices without a camera Intubations that were not recorded (missing data).
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| First attempt intubation success rate | Rate of a successful intubation at first attempt | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall success rate | The overall rate of successful intubation | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Time intervals during intubation | entry-to-tube time (C-MAC crossing the lips to first appearance of tracheal tube in the field of view), time to intubation (C-MAC crossing the lips for the first time until passage of the tube through the vocal cords, the video is kept running throughout the intubation procedure), time between passage of the tube until removal of the blade from the mouth, overall time (from C-MAC crossing the lips for the first time until removal, the video is kept running throughout the intubation procedure), tube time (time from first appearance of the tube in the field until passage of the tube through the vocal cords), intubation time of the successful intubation attempt (C-MAC crossing the lips in the successful attempt until passage of the tube through vocal cords) | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Number of intubation attempts | The total number of attempts needed for the intubation | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Best C/L(Cormack/ Lehane 1-4) grade and best POGO (percent of glottis Opening 0 - 100 %) score | The best C/L and best POGO score achieved during the intubation | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Additional Airway devices used | If additional devices have been used (e.g. Frova-like,catheter, Magill forceps, suction catheter) | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Number of glottic hits | Number of attempts to advance the tracheal tube, but only glottic structures are being hit | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Blade positioning | Blade positioning during intubation (Macintosh vs. Miller) | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Unintended blade positions | Unintended blade positions (too deep, downfolding of epiglottis) | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Secretion in the mouth and difficulties in visualisation because of it | Vomit, blood, saliva | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Fogging of the camera | videolaryngoscope camera clear or fog | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Oesophageal intubation | Oesophageal fail intubation during the procedure | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Injury of the pharyngeal mucose due to the blade | Videolaryngoscope injury of the pharyngeal mucose due to the blade | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured | 
| Open or Closed vocal cords | Positioning of vocal cords if visible (open, closed), start of movement of vocal cords | Starts when the videolaryngoscope is inserted in the patients mouth for the first time and ends when the airway is secured |