• Helmut Trimmel, Janett Kreutziger, Robert Fitzka, Stephan Szüts, Christoph Derdak, Elisabeth Koch, Boris Erwied, and Wolfgang G Voelckel.
• 1Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital, Wiener Neustadt, Austria. 2ÖAMTC Austrian Air Rescue, Vienna, Austria. 3Department of Anesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria. 4Department of Anesthesiology, Mistelbach General Hospital, Mistelbach, Austria. 5Norwegian Air Ambulance, Ålesund, Norway. 6Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Center, Salzburg, Austria. 7AUVA Trauma Center Salzburg, Paracelsus Private Medical University of Salzburg, Salzburg, Austria. 8Department of Health Studies, University of Stavanger, Stavanger, Norway.
• Crit. Care Med. 2016 Jul 1; 44 (7): e470-6.

ObjectivesWe sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting.DesignMulticenter, prospective, randomized, control trial with patient recruitment over 18 months.SettingFour study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway.PatientsAdult emergency patients requiring endotracheal intubation.InterventionsAirway management strictly following a prehospital algorithm. First and second intubation attempt employing GlideScope or direct laryngoscopy as randomized; third attempt crossover. After three failed intubation attempts, immediate use of an extraglottic airway device.Measurements And Main ResultsA total of 326 patients were enrolled. Success rate with the GlideScope (n = 168) versus direct laryngoscopy (n = 158) group was 61.9% (104/168) versus 96.2% (152/158), respectively (p < 0.001). The main reasons for failed GlideScope intubation were failure to advance the tube into the larynx or trachea (26/168 vs 0/158; p < 0.001) and/or impaired sight due to blood or fluids (21/168 vs 3/158; p < 0.001). When GlideScope intubation failed, direct laryngoscopy was successful in 61 of 64 patients (95.3%), whereas GlideScope enabled intubation in four of six cases (66.7%) where direct laryngoscopy failed (p = 0.055). In addition, GlideScope was prone to impaired visualization of the monitor because of ambient light (29/168; 17.3%). There was no correlation between success rates and body mass index, age, indication for airway management, or experience of the physicians, respectively.ConclusionsVideo laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.

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