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

13 Citations (Scopus)

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

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Laryngoscopes
Intubation
Randomized Controlled Trials
Metals
Confidence Intervals
Emergencies
Laryngismus
Nurse Anesthetists
Bronchial Spasm
Laryngoscopy
Emergency Medical Services
Ventricular Tachycardia
Heart Arrest
Hypotension
Plastics
France
Vomiting
Hospital Emergency Service
Tooth

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades : A multicenter randomized controlled trial. / Jabre, Patricia; Galinski, Michel; Ricard-Hibon, Agnes; Devaud, Marie Laure; Ruscev, Mirko; Kulstad, Erik; Vicaut, Eric; Adnet, Fréderic; Margenet, Alain; Marty, Jean; Combes, Xavier.

In: Annals of Emergency Medicine, Vol. 57, No. 3, 01.03.2011, p. 225-231.

Research output: Contribution to journalArticle

Jabre, P, Galinski, M, Ricard-Hibon, A, Devaud, ML, 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, vol. 57, no. 3, pp. 225-231. https://doi.org/10.1016/j.annemergmed.2010.10.011
Jabre, Patricia ; Galinski, Michel ; Ricard-Hibon, Agnes ; Devaud, Marie Laure ; Ruscev, Mirko ; Kulstad, Erik ; Vicaut, Eric ; Adnet, Fréderic ; Margenet, Alain ; Marty, Jean ; Combes, Xavier. / Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades : A multicenter randomized controlled trial. In: Annals of Emergency Medicine. 2011 ; Vol. 57, No. 3. pp. 225-231.
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title = "Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades: A multicenter randomized controlled trial",
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 M{\'e}decine d'Urgence et de R{\'e}animation). 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.",
author = "Patricia Jabre and Michel Galinski and Agnes Ricard-Hibon and Devaud, {Marie Laure} and Mirko Ruscev and Erik Kulstad and Eric Vicaut and Fr{\'e}deric Adnet and Alain Margenet and Jean Marty and Xavier Combes",
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T2 - A multicenter randomized controlled trial

AU - Jabre, Patricia

AU - Galinski, Michel

AU - Ricard-Hibon, Agnes

AU - Devaud, Marie Laure

AU - Ruscev, Mirko

AU - Kulstad, Erik

AU - Vicaut, Eric

AU - Adnet, Fréderic

AU - Margenet, Alain

AU - Marty, Jean

AU - Combes, Xavier

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N2 - 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.

AB - 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.

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