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05.01.2023 | Originalien

Analysis of the primary utilization of videolaryngoscopy in prehospital emergency care in Germany

verfasst von: Dr. Daniel Anthony Koch, Dr. Paul Hagebusch, Dr. Philipp Faul, Prof. Dr. Thorsten Steinfeldt, Prof. Dr. Dr. Reinhard Hoffmann, PD Dr. Uwe Schweigkofler

Erschienen in: Die Anaesthesiologie | Ausgabe 4/2023

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Abstract

Background

In 2019, the German prehospital airway management guidelines were published. One of the recommendations was the primary utilization of videolaryngoscopy (VL) for every prehospital endotracheal intubation (phETI). Guideline compliance is extremely important in emergency medicine as non-compliance in the worst-case scenario leads to death. The study aims to quantify guideline compliance among emergency medical service (EMS) physicians and, subsequently to analyze subgroups influencing compliance.

Material and methods

An online survey was developed and distributed as a hyperlink via email to all medical directors of EMS (n = 155) and the three main operators of helicopter emergency medical services (HEMS) in Germany. The survey was online from August 1^st 2021 until October 3^rd 2021. The primary outcome measure was the primary VL utilization. Data were evaluated descriptively. A multivariate regression analysis was used to determine associations between the primary VL utilization and age, sex, educational level, specialization, phETI per year, operating field, VL device type, and guideline knowledge.

Results

The analysis included 698 EMS physicians. More than 55% of the EMS physicians do not primarily use a videolaryngoscope for phETI. Multivariate regression analysis showed a significantly higher compliance if the devices C‑MAC® or McGrath® were on board, guidelines were known or EMS physicians were female. Age, educational level, specialization or prehospital intubation experience had no significant impact.

Conclusion

The study shows non-compliance with prehospital airway management guidelines in Germany. The guideline recommendation is based on scientific evidence but is not yet generally accepted by all EMS physicians. Videolaryngoscope device type and sex seem to influence the primary VL utilization. Training for EMS physicians must be extended and individual prehospital airway management should be reconsidered by every EMS physician.

Timmermann A, Böttiger BW, Byhahn C, Dörges V, Eich C, Gräsner JT, Hoffmann F, Hossfeld B, Landsleitner B, Piepho T, Noppens R, Russo SG, Wenzel V, Zwißler B, Bernhard M (2019) S1 Leitlinie Prähospitales Atemwegsmanagement (AWMF Online)

Risse J et al (2020) Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study. BMC Emerg Med 20(1):22. https://doi.org/10.1186/s12873-020-00316-zCrossRefPubMedPubMedCentral

Bossers SM, Schwarte LA, Loer SA, Twisk JWR, Boer C, Schober P (2015) Experience in prehospital endotracheal intubation significantly influences mortality of patients with severe traumatic brain injury: A systematic review and meta-analysis. PLoS ONE 10(10):e141034. https://doi.org/10.1371/journal.pone.0141034CrossRefPubMedPubMedCentral

Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K (2018) Expert-performed endotracheal Intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department. Emerg Med Int 2018:5649476. https://doi.org/10.1155/2018/5649476CrossRefPubMedPubMedCentral

Timmermann A et al (2006) Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation 70(2):179–185. https://doi.org/10.1016/j.resuscitation.2006.01.010CrossRefPubMed

Piepho T, Cavus E, Noppens R, Byhahn C, Dörges V, Zwissler B, Timmermann A (2015) S1 Leitlinie: Atemwegsmanagement / Airwaymanagement. AWMF-Register Nr.: 001/028 (AWMF Online)

Deutsche Gesellschaft für Unfallchirurgie (2016) S3 – Leitlinie Polytrauma / Schwerverletzten-Behandlung

Hoogmartens O et al (2014) Evidence-based prehospital management of severe traumatic brain injury: A comparative analysis of current clinical practice guidelines. Prehosp Emerg Care 18(2):265–273. https://doi.org/10.3109/10903127.2013.856506CrossRefPubMed

Perkins GD et al (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 95:81–99. https://doi.org/10.1016/j.resuscitation.2015.07.015CrossRefPubMed

10.

Franschman G et al (2009) Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus reality. Resuscitation 80(10):1147–1151. https://doi.org/10.1016/j.resuscitation.2009.06.029CrossRefPubMed

11.

Myers LA, Russi CS, Hankins DG, Berns KS, Zietlow SP (2009) Efficacy and compliance of a prehospital spinal immobilization guideline. Int J Emerg Med 2(1):1. https://doi.org/10.1007/s12245-009-0082-2CrossRef

12.

Cnossen MC et al (2021) Adherence to guidelines in adult patients with traumatic brain injury: a living systematic review. J Neurotrauma 38(8):1072–1085. https://doi.org/10.1089/neu.2015.4121CrossRefPubMedPubMedCentral

13.

Davis DP et al (2011) The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow coma scale scores of 8 or less. Prehosp Emerg Care 15(2):184–192. https://doi.org/10.3109/10903127.2010.545473CrossRefPubMedPubMedCentral

14.

Chen C, Kan T, Li S, Qiu C, Gui L (2016) Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review. Am J Emerg Med 34(12):2432–2439. https://doi.org/10.1016/j.ajem.2016.09.057CrossRefPubMed

15.

Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362(9391):1225–1230. https://doi.org/10.1016/S0140-6736(03)14546-1CrossRefPubMed

16.

Mann V, Zajonz TS, Mann STW, Müller M, Edeler B, Schneck E, Sander M, Brenck F (2020) Moderne Techniken der präklinischen Notfallmedizin in Deutschland. Fünf-Jahres-Follow-Up einer Erhebung unter den Ärztlichen Leitern Rettungsdienst. Anasth Intensivmed 61:1–14. https://doi.org/10.19224/ai2020.006CrossRef

17.

Eysenbach G (2004) Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 6(3):e34. https://doi.org/10.2196/jmir.6.3.e34. Erratum in: https://doi.org/10.2196/jmir.2042. PMID: 15471760; PMCID: PMC1550605CrossRefPubMedPubMedCentral

18.

Hossfeld B, Frey K, Doerges V, Lampl L, Helm M (2015) Improvement in glottic visualisation by using the C‑MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study. Eur J Anaesthesiol 32(6):425–431. https://doi.org/10.1097/EJA.0000000000000249CrossRefPubMed

19.

Boedeker BH, Bernhagen MA, Miller DJ, Miljkovic N, Kupera GM, Murray WB (2011) Field use of the STORZ C‑MAC^TM video laryngoscope in intubation training with the Nebraska national air guard. Med Meets Virtual Real 18:80–82. https://doi.org/10.3233/978-1-60750-706-2-80CrossRef

20.

Cavus E et al (2011) The C‑MAC videolaryngoscope for prehospital emergency intubation: a prospective, multicentre, observational study. Emerg Med J 28(8):650–653. https://doi.org/10.1136/emj.2010.098707CrossRefPubMed

21.

Piepho T, Fortmueller K, Heid FM, Schmidtmann I, Werner C, Noppens RR (2011) Performance of the C‑MAC video laryngoscope in patients after a limited glottic view using Macintosh laryngoscopy. Anaesthesia 66(12):1101–1105. https://doi.org/10.1111/j.1365-2044.2011.06872.xCrossRefPubMed

22.

Baiardini I, Braido F, Bonini M, Compalati E, Canonica GW (2009) Why do doctors and patients not follow guidelines? Curr Opin Allergy Clin Immunol 9(3):228–233. https://doi.org/10.1097/ACI.0b013e32832b4651CrossRefPubMed

23.

Macke C et al (2020) Increased first pass success with C‑MAC videolaryngoscopy in prehospital endotracheal Intubation—A randomized controlled trial. J Clin Med 9(9):2719. https://doi.org/10.3390/jcm9092719CrossRefPubMedPubMedCentral

24.

Pieters BMA, Maas EHA, Knape JTA, van Zundert AAJ (2017) Videolaryngoscopy vs. direct laryngoscopy use by experienced anaesthetists in patients with known difficult airways: a systematic review and meta-analysis. Anaesthesia 72(12):1532–1541. https://doi.org/10.1111/anae.14057CrossRefPubMed

25.

Carney N et al (2021) Prehospital airway management: A systematic review. Prehosp Emerg Care. https://doi.org/10.1080/10903127.2021.1940400CrossRefPubMed

26.

Powell EK, Hinckley WR, Stolz U, Golden AJ, Ventura A, McMullan JT (2020) Predictors of definitive airway sans hypoxia/hypotension on first attempt (DASH-1A) success in traumatically injured patients undergoing prehospital Intubation. Prehop Emerg Care 24(4):470–477. https://doi.org/10.1080/10903127.2019.1670299CrossRef

27.

Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF (2022) Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011136.pub3CrossRefPubMedPubMedCentral

28.

Gries A, Zink W, Bernhard M, Messelken M, Schlechtriemen T (2005) Einsatzrealität im Notarztdienst. Notf Rettungsmed 8(6):391–398. https://doi.org/10.1007/s10049-005-0756-0CrossRef

29.

Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V (2015) The first shot is often the best shot: first-pass intubation success in emergency airway management. Anesth Analg 121(5):1389–1393. https://doi.org/10.1213/ANE.0000000000000891CrossRefPubMed

30.

Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH (2015) Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia 70(3):272–281. https://doi.org/10.1111/anae.12955CrossRefPubMed

31.

Cooper RM (2018) Implementing universal videolaryngoscopy: how to do it and what to expect. Br J Anaesth 120(1):13–15. https://doi.org/10.1016/j.bja.2017.11.017CrossRefPubMed

32.

Moritz A, Leonhardt V, Prottengeier J, Birkholz T, Schmidt J, Irouschek A (2020) Comparison of Glidescope® Go^TM, King Vision^TM, Dahlhausen VL, I‑View^TM and Macintosh laryngoscope use during difficult airway management simulation by experienced and inexperienced emergency medical staff: A randomized crossover manikin study. PLoS ONE 15(7):e236474. https://doi.org/10.1371/journal.pone.0236474CrossRefPubMedPubMedCentral

33.

Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG (2016) Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth 116(5):670–679. https://doi.org/10.1093/bja/aew058CrossRefPubMed

34.

Mann V et al (2011) Innovative techniques in out-of-hospital emergency medicine in Germany. A five year follow-up internet survey among medical emergency service directors. Anasth Intensivmed 52(11):824–833

Titel: Analysis of the primary utilization of videolaryngoscopy in prehospital emergency care in Germany
verfasst von: Dr. Daniel Anthony Koch
Dr. Paul Hagebusch
Dr. Philipp Faul
Prof. Dr. Thorsten Steinfeldt
Prof. Dr. Dr. Reinhard Hoffmann
PD Dr. Uwe Schweigkofler
Publikationsdatum: 05.01.2023
Verlag: Springer Medizin
Erschienen in: Die Anaesthesiologie / Ausgabe 4/2023
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-022-01247-z

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Springer Medizin

Analysis of the primary utilization of videolaryngoscopy in prehospital emergency care in Germany

Abstract

Background

Material and methods

Results

Conclusion

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Springer Medizin

Abstract

Background

Material and methods

Results

Conclusion

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