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Hyperangulated vs Standard-Geometry Blades and First-Pass Success

June 11, 2020

Written by Aaron Lacy

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Emergency medicine physicians using video laryngoscopes had similar first pass success rates when using either standard-geometry or hyperangulated blades.

Why does this matter?
As video laryngoscopy (VL) moves towards standard of care for emergency department intubation, it is important to know what tools give providers the best chance of first pass success.

“Gotta hit them angles” – Drake, 2018 (probably talking about VL in the ED)
Using NEAR data, 11,927 intubations using VL of patients aged 14 years or older with either standard geometry (SG, n = 7,255) or hyperangulated (HA, n = 4,672) blades were analyzed. After adjustment for confounding variables, the primary outcome of first pass success rate was not associated with either SG or HA blades (SG vs HA, OR 1.32 [95% CI 0.81-2.17]). Rates of adverse events were similar between blade types.

While the big takeaway from this study is that EM physicians are facile with both SG and HA blades, there were several limitations to the study. This was not a randomized controlled study, and while they did logistic regression to account for confounders, the patient’s presentation (e.g. in c-collar) could have played a role in blade selection and success rate. There also was substantial variation of intubation success and preferred initial blade selection between study sites, meaning results may not be generalizable. Until a RCT is done between SG and HA blades, EM physicians should use whatever video blade they are comfortable with and believe the situation dictates.

Comparing Emergency Department First-Attempt Intubation Success With Standard-Geometry and Hyperangulated Video Laryngoscopes. Ann Emerg Med. 2020 Apr 30;S0196-0644(20)30201-8. doi: 10.1016/j.annemergmed.2020.03.011. Online ahead of print.

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