Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades: A multicenter randomized controlled trial

Patricia Jabre, Michel Galinski, Agnes Ricard-Hibon, Marie Laure Devaud, Mirko Ruscev, Erik Kulstad, Eric Vicaut, Fréderic Adnet, Alain Margenet, Jean Marty, Xavier Combes

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Study objective: Emergency tracheal intubation is reported to be more difficult with single-use plastic than with reusable metal laryngoscope blades in both inhospital and out-of-hospital settings. Single-use metal blades have been developed but have not been compared with conventional metal blades. This controlled trial compares the efficacy and safety of single-use metal blades with reusable metal blades in out-of-hospital emergency tracheal intubation. Methods: This randomized controlled trial was carried out in France with out-of-hospital emergency medical units (Services de Médecine d'Urgence et de Réanimation). This was a multicenter prospective noninferiority randomized controlled trial in adult out-of-hospital patients requiring emergency tracheal intubation. Patients were randomly assigned to either single-use or reusable metal laryngoscope blades and intubated by a senior physician or a nurse anesthetist. The primary outcome was first-pass intubation success. Secondary outcomes were incidence of difficult intubation, need for alternate airway devices, and early intubation-related complications (esophageal intubation, mainstem intubation, vomiting, pulmonary aspiration, dental trauma, bronchospasm or laryngospasm, ventricular tachycardia, arterial desaturation, hypotension, or cardiac arrest). Results: The study included 817 patients, including 409 intubated with single-use blades and 408 with a reusable blade. First-pass intubation success was similar in both groups: 292 (71.4%) for single-use blades, 290 (71.1%) for reusable blades. The 95% confidence interval (CI) for the difference in treatments (0.3%; 95% CI -5.9% to 6.5%) did not include the prespecified inferiority margin of -7%. There was no difference in rate of difficult intubation (difference 3%; 95% CI -7% to 2%), need for alternate airway (difference 4%; 95% CI -8% to 1%), or early complication rate (difference 3%; 95% CI -3% to 8%). Conclusion First-pass out-of-hospital tracheal intubation success with single-use metal laryngoscopy blades was noninferior to first-pass success with reusable metal laryngoscope blades.

Original languageEnglish (US)
Pages (from-to)225-231
Number of pages7
JournalAnnals of Emergency Medicine
Volume57
Issue number3
DOIs
StatePublished - Mar 1 2011

ASJC Scopus subject areas

  • Emergency Medicine

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    Jabre, P., Galinski, M., Ricard-Hibon, A., Devaud, M. L., Ruscev, M., Kulstad, E., Vicaut, E., Adnet, F., Margenet, A., Marty, J., & Combes, X. (2011). Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades: A multicenter randomized controlled trial. Annals of Emergency Medicine, 57(3), 225-231. https://doi.org/10.1016/j.annemergmed.2010.10.011