engleski

VIDEO KILLED THE RADIO STAR: EARLY TEACHING AND ADOPTION OF VIDEOLARYNGOSCOPY IN EMERGENCY MEDICINE RESIDENCY TRAINING

Introduction: With the advent of emergency medicine as a medical specialty, a need for training of large volumes of emergency medicine residents in airway management arose, and the role of teaching airway management skills was taken on by experienced anesthesiologists. Although there are many common points in anesthesiologic and emergency medicine airway management, some crucial differences must be appreciated, mainly the facts that emergency medicine trainees perform significantly less intubations during their training than anesthesiology residents, that the first pass success is significantly more important in emergency medicine and that emergency medicine patients usually have significantly worse baseline clinical parameters, including hemodynamics and respiration. Taking those facts into consideration, it is obvious that intubation in the emergency department should be taught and performed using a different approach and tools. This paper aims to review the viability of using videolaryngoscopy as a primary teaching and working tool for intubations in the emergency department. Discussion: A search of the available literature was performed using the PubMed and Google Scholar searching tools. After evaluating the results for relevance to the topic and the quality of methodology and evidence provided, 9 papers were included in this review, of which 8 original research papers and 1 editorial. All of the research papers reviewed analyzed the trainees’ performance parameters relevant to intubation, primarily first attempt success rate and rate of oesophageal intubation, when using videolaryngoscopy (VL) in the education process, in comparison with direct laryngoscopy (DL). Trainees educated using VL as a primary teaching tool had statistically significant improved first attempt rates, with the improvement in the range of 8 – 19% depending on the study. Furthermore, the rate of oesophageal intubation was significantly lower in the VL groups, with one of the studies showing an occurence rate of 0% using VL and 8% using DL. Also, significantly improved intubation times were achieved after training with the DL, ranging from an 11 to 25 second reduction in intubation time depending on the study. Conclusion: The specific context and circumstances of an airway management in emergency medicine need to be taken into account when training residents in airway management. Use of videolaryngoscopy for both education and as a primary tool for the airway management has been shown to improve first attempt success rates, reduce intubation times and reduce the rate of complications like oesophageal intubation. Therefore, VL should be used in the emergency department as a primary teaching and working tool.

education ; emergency medicine ; intubation ; laryngoscopy

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