605-Evaluation of the videolaryngoscope in emergency medicine  Eric Revue Marion Guerrier, Frederic Cocu, Akim Saddar, Stephanie Legros,David Poubel Advances in prehospital airway management  Jacobs PE et all. Int J Crit Illn Inj Sci. 2014 Jan-Mar; 4(1): 57–64.   Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts. | Tags : airway, intubation Emergency Department and prehospital EMS Louis Pasteur Hospital,Chartres (France) erevue@ch-chartres.fr

Conflict of Interest Disclosure Speaker: Title: Member of a scientific committee YES NO ✓ If so: … Speaking or writing in exchange for remuneration YES ✓ NO If so: … Travel expenses and/or registration to congresses or other events covered YES ✓ NO If so: … Leader of research of clinical study YES ✓ NO If so: …

IDS Intubation difficulty scale n attempts > 1 n operator > 1 n alternatives techniques Cormack – 1 Traction force: 0 / 1 BURP: 0 / 1 Cords: abduction 0 adduction 1 IDS 0 none 0-5 light 5 medium to severe ¥ impossible Retrouve ce score dans les études Adnet Anesthesiology 1997 ; 87 :1290-7

distribution des scores de difficulté population hospitalière n=289 0 53,0% > 5 6,3% population préhospitalière n=311 0 28,2% > 5 16,1% >17(impossible) 1cas Souligne importance des conditions intubation Incidence de ID: circonstance et opérateur dépendant Adnet Anesthesiology 1997

Prospective, comparative, randomised study during 6 months. Methods: Prospective, comparative, randomised study during 6 months. Tracheal intubation was attempted by an emergency doctor with extensive experience. Patients were randomly allocated to one of two groups, direct (DL)laryngoscopy vs Mcgrath group(MG). This study was performed to compare DL with MG in terms of time to intubation (TTI), number of attempts and complications and use of difficult intubation equipment. Descriptive analysis of : indications, difficult airway predictors, success, times tu success and complications.   http://www.sfmu.org/Urgences/urgences2014/donnees/communications/resume/resume_252.htm

Videolaryngoscope( 2 attempts) 2 fails Direct Layngoscopy Difficultés de ventilation BURP and new operator ? (only 1 attempt) Fail Success Videolaryngoscope( 2 attempts) Fail Success call for help YES Intubation PLAN « B » NO Ventilation YES NO Help and/or transport to hospital call to prepare « difficult airway management protocol » minitrach

Results : 63 patients enrolled (36 MG vs 27 LG). Time Random Decision to intubate Medical emergency MG success fail DL Results : 63 patients enrolled (36 MG vs 27 LG). Doctors media nage : 46,3 yo Doctors experience : 16 y Random

Direct Laryngoscopy (N = 27) Mac Grath (N = 36) Prehospital EMS 20 (74,07%) 25 (69,44%) Indication Cardiac Arrest Coma 26 ( 96,30%) 11 (40,74%) 5 (18,52%) 31 (86,11%) 11 (30,56%) 7 (19,44%) Difficult airways predictors 12 (33,33%) Success 1st attempt 24 (88,89%) 32 (88,89%) Success 2nd attempt 27 (100%) 36 (100%) Time Average (sec) 31 [0 ; 74,6] 39 [0 ; 86,8] Ttotal 31 [0 ; 88,8] 39 [0 ;99,2 ] Complications 4 (14,81%) 4 (11,11%)

Results (2): 1st creteria Second criteria: time for intubation « p » pour les temps d’intubation est proche de 0,05. La liaison pourrait montrer que les temps d’intubation sont plus longs avec le vidéolaryngoscope McGrath®. Second criteria: time for intubation Mann-Whitney Wilcoxon Test  :p = 0,083.

Study sample is representative of people intubated in IMU in France. Discussion : Study sample is representative of people intubated in IMU in France. This study, which compares DL with MG, demonstrates that MG is not superior. On the other side, TTI and complications are comparable in number while there is more patients with difficult airway predictors in MG group. There is no oesophagial intubation in MG group. This study had several limitations : selection bias and a lack of potency. http://citerahiadesgenettes.hautetfort.com/tag/intubation

Conclusion : This study can’t demonstrate the Mac Grath© is superior to DL in terms of TTI and number of attempts. The Mac Grath© place remains to be definied in emergency medicine.