Amelia L Muhs, Kevin P Seitz, Edward T Qian, Brant Imhoff, Li Wang, Matthew E Prekker, Brian E Driver, Stacy A Trent, Daniel Resnick-Ault, Steven G Schauer, Adit A Ginde, Derek W Russell, Sheetal Gandotra, David B Page, John P Gaillard, Lane M Smith, Andrew J Latimer, Steven H Mitchell, Nicholas J Johnson, Shekhar A Ghamande, Heath D White, Kevin W Gibbs, Jessica A Palakshappa, Derek J Vonderhaar, David R Janz, Micah R Whitson, Christopher R Barnes, Alon Dagan, Ari Moskowitz, Vijay Krishnamoorthy, James T Herbert, Michael D April, Aaron M Joffe, Jeremy P Walco, Christopher G Hughes, Jonathan K Shipley, Amelia W Maiga, Bradley D Lloyd, Stephanie C DeMasi, Wesley H Self, Todd W Rice, Matthew W Semler, Jonathan D Casey
{"title":"心脏骤停后气管插管的视频与直接喉镜检查：器械试验的二次分析。","authors":"Amelia L Muhs, Kevin P Seitz, Edward T Qian, Brant Imhoff, Li Wang, Matthew E Prekker, Brian E Driver, Stacy A Trent, Daniel Resnick-Ault, Steven G Schauer, Adit A Ginde, Derek W Russell, Sheetal Gandotra, David B Page, John P Gaillard, Lane M Smith, Andrew J Latimer, Steven H Mitchell, Nicholas J Johnson, Shekhar A Ghamande, Heath D White, Kevin W Gibbs, Jessica A Palakshappa, Derek J Vonderhaar, David R Janz, Micah R Whitson, Christopher R Barnes, Alon Dagan, Ari Moskowitz, Vijay Krishnamoorthy, James T Herbert, Michael D April, Aaron M Joffe, Jeremy P Walco, Christopher G Hughes, Jonathan K Shipley, Amelia W Maiga, Bradley D Lloyd, Stephanie C DeMasi, Wesley H Self, Todd W Rice, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2024.12.031","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current AHA guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation but do not provide guidance around intubation methods, including the choice of laryngoscope.</p><p><strong>Research question: </strong>Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared to use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest?</p><p><strong>Study design and methods: </strong>This secondary analysis of the Direct versus Video Laryngoscope (DEVICE) trial compared video laryngoscopy versus direct laryngoscopy in the subgroup of patients who were intubated following cardiac arrest. The primary outcome was the incidence of successful intubation on the first attempt. Additional outcomes included the duration of laryngoscopy.</p><p><strong>Results: </strong>Among the 1,417 patients in the DEVICE trial, 113 (7.9%) had experienced cardiac arrest prior to intubation, of whom 48 were randomized to the video laryngoscopy group and 65 to the direct laryngoscopy group. Successful intubation on the first attempt occurred in 40 of 48 patients (83.3%) in the video laryngoscopy group and 42 of 65 patients (64.6%) in the direct laryngoscopy group (absolute risk difference, 18.7 percentage points; 95% confidence interval [CI], 1.2 to 36.2; P = 0.03). The mean duration of laryngoscopy was 48.0 seconds (standard deviation [SD], 37.3 seconds) in the video laryngoscope group and 98.0 seconds (SD, 122.4) in the direct laryngoscopy group (mean difference, -50.0; 95% CI, -86.8 to -13.3, P = 0.004).</p><p><strong>Interpretation: </strong>Among adults undergoing tracheal intubation after experiencing cardiac arrest, use of video laryngoscopy was associated with increased incidence of successful intubation on the first attempt and shortened duration of laryngoscopy, compared to use of direct laryngoscopy.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial.\",\"authors\":\"Amelia L Muhs, Kevin P Seitz, Edward T Qian, Brant Imhoff, Li Wang, Matthew E Prekker, Brian E Driver, Stacy A Trent, Daniel Resnick-Ault, Steven G Schauer, Adit A Ginde, Derek W Russell, Sheetal Gandotra, David B Page, John P Gaillard, Lane M Smith, Andrew J Latimer, Steven H Mitchell, Nicholas J Johnson, Shekhar A Ghamande, Heath D White, Kevin W Gibbs, Jessica A Palakshappa, Derek J Vonderhaar, David R Janz, Micah R Whitson, Christopher R Barnes, Alon Dagan, Ari Moskowitz, Vijay Krishnamoorthy, James T Herbert, Michael D April, Aaron M Joffe, Jeremy P Walco, Christopher G Hughes, Jonathan K Shipley, Amelia W Maiga, Bradley D Lloyd, Stephanie C DeMasi, Wesley H Self, Todd W Rice, Matthew W Semler, Jonathan D Casey\",\"doi\":\"10.1016/j.chest.2024.12.031\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. 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Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial.
Background: Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current AHA guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation but do not provide guidance around intubation methods, including the choice of laryngoscope.
Research question: Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared to use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest?
Study design and methods: This secondary analysis of the Direct versus Video Laryngoscope (DEVICE) trial compared video laryngoscopy versus direct laryngoscopy in the subgroup of patients who were intubated following cardiac arrest. The primary outcome was the incidence of successful intubation on the first attempt. Additional outcomes included the duration of laryngoscopy.
Results: Among the 1,417 patients in the DEVICE trial, 113 (7.9%) had experienced cardiac arrest prior to intubation, of whom 48 were randomized to the video laryngoscopy group and 65 to the direct laryngoscopy group. Successful intubation on the first attempt occurred in 40 of 48 patients (83.3%) in the video laryngoscopy group and 42 of 65 patients (64.6%) in the direct laryngoscopy group (absolute risk difference, 18.7 percentage points; 95% confidence interval [CI], 1.2 to 36.2; P = 0.03). The mean duration of laryngoscopy was 48.0 seconds (standard deviation [SD], 37.3 seconds) in the video laryngoscope group and 98.0 seconds (SD, 122.4) in the direct laryngoscopy group (mean difference, -50.0; 95% CI, -86.8 to -13.3, P = 0.004).
Interpretation: Among adults undergoing tracheal intubation after experiencing cardiac arrest, use of video laryngoscopy was associated with increased incidence of successful intubation on the first attempt and shortened duration of laryngoscopy, compared to use of direct laryngoscopy.
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At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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