Why the VideoLarygoscopy don’t gonna kill the DirectLaryngoscopy star

13 Dic

A novel publication goes to enrich the long-living debate on direct laryngoscopy (DL) vs video laryngoscopy (VL) efficacy in emergency intubation.

The recent article pubblished on JEMS “Deploying the Video Laryngoscope into a Ground EMS System” compare the success rate beetwen DL vs VL in a ground EMS Service. The device used was the King Vision with channeled blade. The partecipants had a quik training consisting in didactic orientation and practical skills on manikins.

The result of the study shown that “Within the first 100 days of the study, the video laryngoscope utilizing the channeled blade has shown to be at least as effective as DL in relation to first-attempt success” and considering that “the mean experience in our group with DL is nine years, yet the success rate remains unacceptable” “It’s time to consider transition from a skill that’s difficult to obtain and maintain to one that appears to have a quicker learning curve and will likely result in decreased episodes of multiple attempts at intubation and associated complications.”

So is direct laryngoscopy dead?( Or will be so in a few years)

Laryndo dead

Here is what I think

There are some fundamental differences in  VL tecnique respect the DL tecnique, that makes the DL more intuitive to pass the tube trough the cords.

We have basically 3 main axis in the airways

3axys

When we manage the airways we first put the head in “sniffing position” aligning the pharyngeal axis with the laryngeal one

Sniffing position

Then we use the laryngoscope to align the mouth axis having so a direct view of the cords. This view coincide with the way to pass the tube, making this step intitive and easy.

DL view

 

 

 

 

 

 

 

 

 

 

 

 

Using the videolaryngoscope we take our eyes right in front of the larynx, having a perfect “video” view of the vocal cords, but also minimally modifying the axis of the mouth.

Visione in videolaringoscopia

For this reason passing the OTT is not straight forward, so we need the stylet, the Bougie/Froban or the external glottic maneuvers, to facilitate the intubation.

tubo stylet

Bougie

 

 

 

 

 

 

 

 

 

This difference in tecnique makes the VL a little tricky in sense of the contrast between the perfect laryngeal view and the not  intuitive passage of the tube trogh the cords.

The learning curve is

So I’ll ask you:

Wich way you prefer to go home?

The quickest and the shorter one for shure!

Do you use the GPS to go home?

Agree, me neither!

And when you use it?

lost

Right! When you are lost!

So that’s why Direct Laryngoscope il still my Plan A

My straight way home!

straight road

Prehospital Airway Management Action Plan

2 Risposte to “Why the VideoLarygoscopy don’t gonna kill the DirectLaryngoscopy star”

  1. nconway 14 dicembre 2012 a 9:24 PM #

    Disagree no need for stylet

    • medest118 15 dicembre 2012 a 8:54 AM #

      If you don’t use a stylet you need to apply some basics tricks. Visualaze the epiglottis first, stay in the vallecula with the blade as withe DL so you don’t lift the glottic plan. Now you don’t need a stylet. But why don’t using the stylet as we do routinelly?

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