The effect of stylet choice on the success rate of intubation using the GlideScope video laryngoscope in the emergency department

Objectives: The objective was to determine whether the using the GlideRite rigid stylet (GRS) compared with a standard malleable stylet (SMS) affects the success rate of intubation using the GlideScope in emergency intubations.

Methods: This was a retrospective analysis of prospectively collected continuous quality improvement (CQI) data based on intubations performed in an academic emergency department (ED) over a 4-year period. Following each intubation the operator completed a data form regarding multiple aspects of the intubation, including the device used, type of stylet used, procedural complications, outcome of the intubation, difficult airway predictors (DAPs), and the operator's postgraduate year (PGY). Intubation was considered successful if the GlideScope was used as the initial device and resulted in successful intubation of the trachea.

Results: Over the 4-year study period, the GlideScope video laryngoscope (GVL) was used for 473 intubations. Of these, 322 (68%) used the GRS, while 151 (32%) used the SMS. When the GRS was used, operators were ultimately successful in 93.5% of cases (301 of 322), whereas when the SMS was used, operators were successful in 78.1% of cases (118 of 151; p < 0.0001). The first-attempt success rate for the GRS group was 82.9% (267 of 322) and for the SMS group was 67.5% (102 of 151; p < 0.001). The mean (± standard deviation [SD]) complication rate was 0.25 (±0.5) in the GRS group and was 0.47 (±0.7) in the SMS group (p = 0.0003). In the GRS group, 18% of patients (58 of 322) had oxygen desaturation, while in the SMS group, 31% of patients (46 of 151) had oxygen desaturation (p = 0.003). The mean number of DAPs was 2.0 (±1.5) in the GRS group and 2.0 (±1.5) in the SMS group (p = 0.65). The mean (±SD) PGY of the operator was 2.2 (±0.8) years in the GRS group and 2.2 (±0.8) years in the SMS group (p = 0.79).

Conclusions: Both first-attempt and ultimate success rates were higher with GlideScope intubations in the ED when the rigid stylet was used compared to the malleable stylet. The number of complications and, in particular, the incidence of oxygen desaturation were lower in the GRS group than in the SMS group. The two stylet groups were similar regarding difficulty of the airway and experience level of the operator.