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REVIEW

Endotracheal Intubation of Difficult Airways in Emergency Settings: A Guide for Innovators

, ORCID Icon, &
Pages 183-199 | Received 04 May 2023, Accepted 05 Jul 2023, Published online: 18 Jul 2023

References

  • National Hospital Ambulatory Medical Care Survey. 2018 emergency department summary tables; 2018.
  • Chua MT, Khan FA, Ng WM, et al. Pre- and apnoeic high flow oxygenation for RApid sequence intubation in the emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial. Trials. 2019;20(1):195. doi:10.1186/s13063-019-3305-8
  • Kim YS, Song J, Lim BG, Lee IO, Won YJ. Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: a systematic review and network meta-analysis. PLoS One. 2020;15(8):e0238060. doi:10.1371/journal.pone.0238060
  • Kim C, Kang HG, Lim TH, Choi BY, Shin YJ, Choi HJ. What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments? Emerg Med J. 2013;30(11):888–892. doi:10.1136/emermed-2012-201708
  • De Jong A, Molinari N, Pouzeratte Y, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth. 2015;114(2):297–306. doi:10.1093/bja/aeu373
  • Koh W, Kim H, Kim K, Ro YJ, Yang HS. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol. 2016;69(3):244–249. doi:10.4097/kjae.2016.69.3.244
  • UpToDate. Management of the difficult airway for general anesthesia in adults; 2023. https://www.uptodate.com/contents/management-of-The-difficult-airway-for-general-anesthesia-in-adults. Accessed June 20, 2023.
  • Pacheco GS, Hurst NB, Patanwala AE, Hypes C, Mosier JM, Sakles JC. First pass success without adverse events is reduced equally with anatomically difficult airways and physiologically difficult airways. West J Emerg Med. 2021;22(2):360–368. doi:10.5811/westjem.2020.10.48887
  • Amornyotin S, Prakanrattana U, Vichitvejpaisal P, Vallisut T, Kunanont N, Permpholprasert L. Comparison of the clinical use of Macintosh and Miller laryngoscopes for orotracheal intubation by second-month nurse students in anesthesiology. Anesthesiol Res Pract. 2010;2010. doi:10.1155/2010/432846
  • Parotto M, Cooper R. Recent advances in laryngoscopy in adults. F1000Res. 2019;8:797. doi:10.12688/f1000research.18544.1
  • Bailey B. Laryngoscopy and laryngoscopes--who’s first?: the forefathers/four fathers of laryngology. Laryngoscope. 1996;106(8):939–943. doi:10.1097/00005537-199608000-00005
  • Burkle CM, Zepeda FA, Bacon DR, Rose SH. A historical perspective on use of the laryngoscope as a tool in anesthesiology. Anesthesiology. 2004;100(4):1003–1006. doi:10.1097/00000542-200404000-00034
  • Henderson J. Airway management in the adult. In: Miller’s Anesthesia. Elsevier; 2010:1573–1610.
  • Unzueta MC, Casas JI, Merten A. Macintosh’s laryngoscope. J Am Soc Anesthesiol. 2005;102(1):242.
  • van Zundert A, Pieters B, Doerges V, Gatt S. Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy. Br J Anaesth. 2012;109(6):1014–1015. doi:10.1093/bja/aes418
  • Yong SA, Chaou CH, Yu SR, et al. Video assisted laryngoscope facilitates intubation skill learning in the emergency department. J Acute Med. 2020;10(2):60–69. doi:10.6705/j.jacme.202003_10(2).0002
  • Thaler. Cost comparison of 2 video laryngoscopes in a large academic center. J Clin Outcomes Manag. 2021;28(4). doi:10.12788/jcom.0055
  • Şahiner Y. Indications for endotracheal intubation. Tracheal Intubation; 2018. Available from: https://books.google.com/books?hl=en&lr=&id=HXeQDwAAQBAJ&oi=fnd&pg=PA59&dq=%C5%9Eahiner+Y+Indications+for+Endotracheal+Intubation+IntechOpen+2018&ots=B2UHSZjrl9&sig=KOk838VG4vWW42I9uJ5cWoZ95rg. Accessed July 13, 2023.
  • Jung JY. Airway management of patients with traumatic brain injury/C-spine injury. Korean J Anesthesiol. 2015;68(3):213–219. doi:10.4097/kjae.2015.68.3.213
  • Peterson K, Ginglen JG, Desai NM, Guzman N. Direct laryngoscopy. In: StatPearls. StatPearls Publishing; 2023.
  • Themes UFO. The difficult airway. Anesthesia Key; 2018. Available from: https://aneskey.com/the-difficult-airway-3/. Accessed June 20, 2023.
  • Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the glidescope in difficult airway management: an analysis of 2004 glidescope intubations, complications, and failures from two institutions. Anesthesiology. 2011;114:5. doi:10.1097/ALN.0b013e3182023eb7
  • Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. 2020;132(6):1317–1332. doi:10.1097/ALN.0000000000003296
  • Di Domenico SL, Coen D, Bergamaschi M, et al. Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study. Intern Emerg Med. 2021;16(4):1051–1060. doi:10.1007/s11739-020-02548-0
  • Baek MS, Han M, Huh JW, Lim CM, Koh Y, Hong SB. Video laryngoscopy versus direct laryngoscopy for first-attempt tracheal intubation in the general ward. Ann Intensive Care. 2018;8(1):83. doi:10.1186/s13613-018-0428-0
  • Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg. 2014;9:117. doi:10.1186/1749-8090-9-117
  • Yu JE, Lin RY. The epidemiology of anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366–374. doi:10.1007/s12016-015-8503-x
  • Reed MJ, Dunn MJG, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 2005;22(2):99–102. doi:10.1136/emj.2003.008771
  • Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest. 2000;118(4):1100–1105. doi:10.1378/chest.118.4.1100
  • Jain S, Iverson LM. Glasgow Coma Scale. StatPearls Publishing; 2022.
  • Adnet F, Borron SW, Finot MA, Lapandry C, Baud FJ. Intubation difficulty in poisoned patients: association with initial Glasgow Coma scale score. Acad Emerg Med. 1998;5(2):123–127. doi:10.1111/j.1553-2712.1998.tb02596.x
  • Latimer AJ, Harrington B, Counts CR, et al. Routine use of a bougie improves first-attempt intubation success in the out-of-hospital setting. Ann Emerg Med. 2021;77(3):296–304. doi:10.1016/j.annemergmed.2020.10.016
  • Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607–613. doi:10.1213/01.ANE.0000122825.04923.15
  • Saracoglu KT, Yilmaz M, Turan AZ, et al. Evaluation of rescue techniques following failed laryngoscopy: a multicenter prospective observational study. North Clin Istanb. 2023;10(2):212–221. doi:10.14744/nci.2021.76402
  • Kj DP, Shekar B. Adverse events in failed first-pass intubation vs. Successful first-pass intubation in the emergency department - an analytical hospital-based study. J Evid Based Med Healthc. 2021;8(06):283–287. doi:10.18410/jebmh/2021/55
  • Arino JJ, Velasco JM, Gasco C, Lopez-Timoneda F. Straight blades improve visualization of the larynx while curved blades increase ease of intubation: a comparison of the Macintosh, Miller, McCoy, Belscope and Lee-Fiberview blades. Can J Anaesth. 2003;50(5):501–506. doi:10.1007/BF03021064
  • Collins SR. Direct and Indirect Laryngoscopy: equipment and TechniquesDiscussion. Respir Care. 2014;59(6):850–864. doi:10.4187/respcare.03033
  • Wojewodzka-Zelezniakowicz M, Madziala A, Madziala M. Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study. Disaster Emerg Med J. 2017;2. doi:10.5603/DEMJ.2017.0001
  • Gawlowski P, Smereka J, Madziala M, Szarpak L, Frass M, Robak O. Comparison of the Macintosh laryngoscope and blind intubation via the iGEL for intubation with C-spine immobilization: a randomized, crossover, manikin trial. Am J Emerg Med. 2017;35(3):484–487. doi:10.1016/j.ajem.2016.11.064
  • Goto T, Goto Y, Hagiwara Y, Okamoto H, Watase H, Hasegawa K. Advancing emergency airway management practice and research. Acute Med Surg. 2019;6(4):336–351. doi:10.1002/ams2.428
  • Berkow LC, Morey TE, Urdaneta F. The Technology of Video Laryngoscopy. Anesth Analg. 2018;126(5):1527. doi:10.1213/ANE.0000000000002490
  • Airtraq. Airtraq; 2016. Available from: https://www.airtraq.com/. Accessed June 20, 2023.
  • GlideScope medical devices. Available from: https://www.verathon.com/glidescope/. Accessed June 20, 2023.
  • Breedon P, Siena F, Armstrong J. Tracheal intubation: improving first pass success with smart material solutions. J Healthc Des. 2017;2(3):15–18.
  • UpToDate. Extraglottic devices for emergency airway management in adults. Available from: https://www.uptodate.com/contents/extraglottic-devices-for-emergency-airway-management-in-adults. Accessed June 20, 2023.
  • Das B, Mitra S, Jamil SN, Varshney RK. Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery. Saudi J Anaesth. 2012;6(3):224–228. doi:10.4103/1658-354X.101212
  • Cost of unplanned tracheal intubation: evidence from the premier hospital database. Available from: http://www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2015&index=14&absnum=4676. Accessed June 20, 2023.
  • Ostermayer DG, Gausche-Hill M. Supraglottic airways: the history and current state of prehospital airway adjuncts. Prehosp Emerg Care. 2014;18(1):106–115. doi:10.3109/10903127.2013.825351
  • Das B, Mitra S, Samanta A, Vijay BS. Comparison of i-gelTM supraglottic device with classic laryngeal mask airway in anesthetized paralyzed children undergoing elective surgery. Anesth Essays Res. 2012;6(2):180–183. doi:10.4103/0259-1162.108305
  • Pournajafian A, Alimian M, Rokhtabnak F, Ghodraty M, Mojri M. Success rate of airway devices insertion: laryngeal mask airway versus supraglottic gel device. Anesth Pain Med. 2015;5(2):e22068. doi:10.5812/aapm.22068
  • Offenbacher J, Nikolla DA, Carlson JN, et al. Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: a National Emergency Airway Registry (NEAR) study. Am J Emerg Med. 2023;68:22–27. doi:10.1016/j.ajem.2023.02.020
  • Heymans F, Feigl G, Graber S, Courvoisier DS, Weber KM, Dulguerov P. Emergency cricothyrotomy performed by surgical airway–naive medical personnel: a randomized crossover study in cadavers comparing 3 commonly used techniques. Obstet Anesth Dig. 2017;37(2):79. doi:10.1097/01.aoa.0000515750.60577.e7
  • Mulcaster JT, Mills J, Hung OR, et al. Laryngoscopic intubation: learning and performance. Anesthesiology. 2003;98(1):23–27. doi:10.1097/00000542-200301000-00007
  • Raja AS, Sullivan AF, Pallin DJ, Bohan JS, Camargo CA Jr. Adoption of video laryngoscopy in Massachusetts emergency departments. J Emerg Med. 2012;42(2):233–237. doi:10.1016/j.jemermed.2010.10.020
  • Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31–81. doi:10.1097/ALN.0000000000004002
  • Carlson JN, Das S, De la Torre F, et al. A novel artificial intelligence system for endotracheal intubation. Prehosp Emerg Care. 2016;20(5):667–671. doi:10.3109/10903127.2016.1139220
  • Zang Q, Cui H, Guo X, Lu Y, Zou Z, Liu H. Clinical value of video-assisted single-lumen endotracheal intubation and application of artificial intelligence in it. Am J Transl Res. 2022;14(11):7643–7652.
  • Hayasaka T, Kawano K, Kurihara K, Suzuki H, Nakane M, Kawamae K. Creation of an artificial intelligence model for intubation difficulty classification by deep learning (convolutional neural network) using face images: an observational study. J Intensive Care Med. 2021;9(1):38. doi:10.1186/s40560-021-00551-x
  • Zhou CM, Wang Y, Xue Q, Yang JJ, Zhu Y. Predicting difficult airway intubation in thyroid surgery using multiple machine learning and deep learning algorithms. Front Public Health. 2022;10:937471. doi:10.3389/fpubh.2022.937471
  • Di Napoli A, Tagliente E, Pasquini L, et al. 3D CT-inclusive deep-learning model to predict mortality, ICU admittance, and intubation in COVID-19 patients. J Digit Imaging. 2023;36(2):603–616. doi:10.1007/s10278-022-00734-4
  • Fiala A, Lederer W, Neumayr A, et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - A multicenter prospective randomized trial. Scand J Trauma Resusc Emerg Med. 2017;25(1):104. doi:10.1186/s13049-017-0446-1
  • Effective use of oropharyngeal and nasopharyngeal airways. ACLS.com. 2019. Available from: https://acls.com/articles/nasopharyngeal-oropharyngeal-airways/. Accessed June 20, 2023.
  • Narang AT, Oldeg PF, Medzon R, Mahmood AR, Spector JA, Robinett DA. Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simul Healthc. 2009;4(3):160–165. doi:10.1097/SIH.0b013e318197d2e5
  • Shop our products. Available from: https://mms.mckesson.com/catalog?utm_campaign=mms+inline+links&utm_medium=referral&sort=&utm_source=McKesson.com. Accessed January 2022.
  • MedicalExpo. The B2B marketplace for medical equipment: medical material, medical imagery, hospital furniture, laboratory equipment, etc. Available from: https://www.medicalexpo.com/. Accessed June 20, 2023.
  • Medical supplies and products from top manufacturers for EMS providers - theEMSstore. Available from: https://www.theemsstore.com/. Accessed June 20, 2023.
  • Lascarrou JB, Boisrame-Helms J, Bailly A, et al. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317(5):483–493. doi:10.1001/jama.2016.20603
  • Nicholson A, Cook TM, Smith AF, Lewis SR, Reed SS. Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients. Cochrane Database Syst Rev. 2013. doi:10.1002/14651858.CD010105.pub2
  • Endotracheal tube market size, share & trends analysis report by product type (regular, reinforced), by route type (orotracheal, nasotracheal), by application, by end-user, by region, and segment forecasts, 2023–2030. Available from: https://www.grandviewresearch.com/industry-analysis/endotracheal-tubes-market. Accessed June 20, 2023.
  • Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014;4(1):65–70. doi:10.4103/2229-5151.128015
  • Schober P, Biesheuvel T, de Leeuw MA, Loer SA, Schwarte LA. Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches. BMC Emerg Med. 2019;19(1):12. doi:10.1186/s12873-019-0230-9
  • Driver BE, Prekker ME, Klein LR, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496
  • de Alencar JCG, Marques B, Marchini JFM, et al. First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation. J Am Coll Emerg Phys Open. 2020;1(5):699–705. doi:10.1002/emp2.12219
  • Eric M, Rottenberg AAS. Increasing intubation first-attempt success rates in patients of all ages. EMS Airway. 2020. Available from: https://emsairway.com/2020/09/29/increasing-intubation-first-attempt-success-rates-in-patients-of-all-ages/. Accessed June 20, 2023.
  • Joshi R, Hypes CD, Greenberg J, et al. Difficult airway characteristics associated with first-attempt failure at intubation using video laryngoscopy in the intensive care unit. Ann Am Thorac Soc. 2017;14(3):368–375. doi:10.1513/AnnalsATS.201606-472OC
  • von Goedecke A, Bowden K, Wenzel V, Keller C, Gabrielli A. Effects of decreasing inspiratory times during simulated bag-valve-mask ventilation. Resuscitation. 2005;64(3):321–325. doi:10.1016/j.resuscitation.2004.09.003
  • Ahmed SM, Doley K, Athar M, Raza N, Siddiqi OA, Ali S. Comparison of endotracheal intubation time in neutral position between C-Mac® and Airtraq® laryngoscopes: a prospective randomised study. Indian J Anaesth. 2017;61(4):338–343. doi:10.4103/ija.IJA_564_16
  • Castle N, Owen R, Hann M, Naidoo R, Reeves D. Assessment of the speed and ease of insertion of three supraglottic airway devices by paramedics: a manikin study. Emerg Med J. 2010;27(11):860–863. doi:10.1136/emj.2009.084343
  • Eglen M, Kuvaki B, Günenç F, et al. Comparação de três técnicas diferentes de inserção com a máscara laríngea LMA‐Unique™ em adultos: resultados de um estudo randômico [Comparison of three different insertion techniques with LMA-UniqueTM in adults: results of a randomized trial]. Rev Bras Anestesiol. 2017;67(5):521–526. French. doi:10.1016/j.bjan.2017.04.007
  • Huang TY, Lin JR, Chung YT. A preinstalled nasopharyngeal airway in the right nasal passageway to facilitate nasogastric intubation in anesthetized and intubated patients: a prospective randomized controlled trial. BMC Gastroenterol. 2020;20(1):365. doi:10.1186/s12876-020-01514-6
  • Jooste WJL, van Hoving DJ. The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape. Afr J Emerg Med. 2015;5(1):19–23. doi:10.1016/j.afjem.2014.11.001
  • Chao A, Chou WH, Huang HH, Yeh YC, Lin CJ. Evaluation of tracheal intubation: a retrospective study of skill acquisition by medical students in the operating theater. J Formos Med Assoc. 2015;114(9):855–859. doi:10.1016/j.jfma.2013.07.019
  • Singhal SK, Kaur K, Yadav P. A study to evaluate the role of experience in acquisition of the skill of orotracheal intubation in adults. J Anaesthesiol Clin Pharmacol. 2021;37(3):469–474. doi:10.4103/joacp.JOACP_133_19
  • Woollard M, Mannion W, Lighton D, et al. Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy. Anaesthesia. 2007;62(10):1061–1065. doi:10.1111/j.1365-2044.2007.05215.x
  • Moucharite MA, Zhang J, Giffin R. Factors and economic outcomes associated with documented difficult intubation in the United States. Clinicoecon Outcomes Res. 2021;13:227–239. doi:10.2147/CEOR.S304037
  • Anesthesia Airway Management (AAM). Home. Available from: https://aam.ucsf.edu/. Accessed June 20, 2023.
  • Wong E, Ng YY. The difficult airway in the emergency department. Int J Emerg Med. 2008;1(2):107–111. doi:10.1007/s12245-008-0030-6
  • Long E, Sabato S, Babl FE. Endotracheal intubation in the pediatric emergency department. Paediatr Anaesth. 2014;24(12):1204–1211. doi:10.1111/pan.12490
  • Turner JS, Bucca AW, Propst SL, et al. Association of checklist use in endotracheal intubation with clinically important outcomes: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278
  • Pfuntner A, Wier LM, Stocks C. Most frequent procedures performed in U.S. hospitals, 2011. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US); 2013.
  • Waite LJ. The demographic faces of the elderly. Popul Dev Rev. 2004;30(Supplement):3–16.
  • Mitchell NS, Catenacci VA, Wyatt HR, Hill JO. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–732. doi:10.1016/j.psc.2011.08.005
  • Global Industry Analysts, Inc. Global airway management devices market to reach $1.8 billion by 2024. PR Newswire; 2021. Available from: https://www.prnewswire.com/news-releases/global-airway-management-devices-market-to-reach-1-8-billion-by-2024--301350115.html. Accessed June 20, 2023.
  • Zenios S, Makower J, Yock P. Biodesign: The Process of Innovating Medical Technologies. Cambridge University Press; 2010.
  • Phillips K, Moucharite M, Wong T, May R. Cost burden associated with difficult intubation in the United States. Trends Anaesth Crit Care. 2020;30:e131. doi:10.1016/j.tacc.2019.12.320