Impact of Laryngoscopy Type on Intubation Success Rate

Abstract

Background: At our institution, respiratory therapists may be certified to perform endotracheal intubation in the adult population. Annual intubation certification includes both performing a certain number of successful endotracheal intubations as well as a passing a skills and knowledge test. Our practice has transitioned in the past few years from primarily using direct laryngoscopy to using video laryngoscopy. In the past, direct laryngoscopy was the main method available. Recently, our system placed a video laryngoscopy platform in all adult ICUs and Emergency Departments. We wanted to determine if respiratory therapists at our facility were more successful with endotracheal intubation when using video laryngoscopy. Methods: A retrospective review of intubation documentation by respiratory therapists was conducted for two different periods, January 2015 to December 2016 (direct - primary laryngoscopy type) and July 2017 to May 2019 (video - primary laryngoscopy type). Successful tracheal intubation versus unsuccessful tracheal intubation attempt were noted for each occurrence of intubation by a respiratory therapist. Data was also collected specifically for video versus direct laryngoscopy from January 2019 to May 2019, when video vs direct was added to the electric medical record as a discreet data element. Results: See data table for success rate during the time when direct (Jan 15-Dec 16) and video (Jul 17-May 19) were the primary type of laryngoscopy. Success rate increased 8% from 86% to 94% when video laryngoscopy became the primary type. The table also includes discreet data from January 2019 to May 2019 comparing video versus direct success rate. Video is currently used 3 times more frequently than direct (100 vs 32) and has a success rate 8% higher than direct. Conclusions: The success rate of a respiratory therapists certified in endotracheal intubation increased 8% when video laryngoscopy became readily available in our system. With both types currently available, respiratory therapists opt to use video laryngoscopy three times more frequently.