Each month several of our residents prepare and present a topic based on a clinical question generated during a shift. These presentations invariably generate healthy discussion among the group present at didactics. They start with a question rather than a known body of evidence. Therefore, the question may remain without a definite answer supported by high-level evidence. The exercise is meant to prioritize the practice of seeking evidence-based answers to everyday clinical questions. Summaries of these presentations are posted here monthly.
DL Vs. VL
By Dr. Brandon Roe
Brief patient presentation
62 yo F with a PMH of COPD and multiple intubations comes in with difficulty breathing. Upon entering the room the patient is noted to be tripoding and in obvious respiratory distress.
Clinical question – PICO
In patients presenting to the emergency department requiring endotracheal intubation, does the use of video laryngoscopy vs direct laryngoscopy improve first pass success rate and decrease adverse events?
Available research – list references and assign levels of evidence
Driver, B. E., Prekker, M. E., Moore, J. C., Schick, A. L., Reardon, R. F., & Miner, J. R. (2016). Direct Versus Video Laryngoscopy Using the C-MAC for Tracheal Intubation in the Emergency Department, a Randomized Controlled Trial. Acad Emerg Med Academic Emergency Medicine, 23(4), 433-439. doi:10.1111/acem.12933 -Level 2
Sakles, J. C., Mosier, J., Chiu, S., Cosentino, M., & Kalin, L. (2012). A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department. Annals of Emergency Medicine, 60(6), 739-748. doi:10.1016/j.annemergmed.2012.03.031 -Level 2
Does the literature in your search answer the question? Not definitively
Does your search reveal a POEM? No
How will you proceed the next time this problem is encountered? Use the video laryngoscope with monitor turned away for DL practice with immediate availability of VL if needed for patient circumstance or practice.