Perioperative Medicine  |   October 2016
Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group
Author Notes
  • From the Department of Anesthesiology, Oregon Health & Science University, Portland, Oregon (M.F.A., A.M.B.); Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (D.W.H., A.S., T.T., J. Ragheb, S.K.); Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (A.W.W.); Department of Anesthesiology, University of Colorado, Aurora, Colorado (L.J.); Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (D.A.B.); Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont (W.C.P.); Department of Anesthesiology, Washington University, St. Louis, Missouri (J. Rao); Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee (J.L.E.); Department of Anesthesiology, University of Virginia, Charlottesville, Virginia (D.A.C.); and Department of Anesthesiology, University of Utah, Salt Lake City, Utah (P.B.).
  • This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.
    This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.×
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Corresponding article on page 615.
    Corresponding article on page 615.×
  • This work was an oral abstract presentation at the American Society of Anesthesiologists Annual Meeting in New Orleans, Louisiana, on October 14, 2014.
    This work was an oral abstract presentation at the American Society of Anesthesiologists Annual Meeting in New Orleans, Louisiana, on October 14, 2014.×
  • Submitted for publication June 20, 2015. Accepted for publication June 14, 2016.
    Submitted for publication June 20, 2015. Accepted for publication June 14, 2016.×
  • Address correspondence to Dr. Aziz: Mail Code KPV 5A, 3181 Sam Jackson Park Rd., Portland, Oregon 97239. azizm@ohsu.edu. This article may be accessed for personal use at no charge through the Journal Web site, www.anesthesiology.org.
Article Information
Perioperative Medicine / Clinical Science / Airway Management / Respiratory System
Perioperative Medicine   |   October 2016
Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group
Anesthesiology 10 2016, Vol.125, 656-666. doi:10.1097/ALN.0000000000001267
Anesthesiology 10 2016, Vol.125, 656-666. doi:10.1097/ALN.0000000000001267
Abstract

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.