• A Video Peek at Deep Throat • MedicalExpo e-Magazine
    The Smart Magazine About Medical Technology Innovations

    #31 - Emergency Medicine

    A Video Peek at Deep Throat

    Video laryngoscopy (VL) offers striking magnification for examining parts of the airway that are difficult to see with the naked eye. The technique is catching on in prehospital settings, to replace direct laryngoscopy (DL).

     

    Dr. Marvin Wayne is medical director of Whatcom County Medic One, which provides paramedic services in and around Bellingham, Washington.

    When you are working on the roadside, in a ditch or helicopter […] usual intubation becomes unusual and video laryngoscopy is better than direct laryngoscopy. Direct laryngoscopy is a dinosaur in search of a tarpit.

    VL vs. DL

    What wows Wayne are the dynamic, real-time views of the entire throat, superb on-screen magnification, video recording and customization permitting intubation of everyone from newborns to the morbidly obese.

    Video laryngoscopy got its start in the operating theater, gaining favor with prehospital and emergency medical services only recently. Initially, VL was proposed for predictably difficult airways. But many paramedics have pushed for more widespread use because of its advanced technological capabilities, performance in difficult situations and excellence for teaching.

    “Video laryngoscopes may reduce the number of failed intubations.”

    Studies of first-pass success comparing video to direct laryngoscopy abound. Many demonstrate that VL offers more successful intubation and that practitioners improve with experience.

    Jeff Jarvis, medical director of the Williamson County EMS Services in Texas told Medical Expo e-magazine that he has been working hard to improve VL quality. In the training sessions he led, baseline VL intubation success rates were between 43% and 70%. After training, the rates climbed to 90% or higher, on a par with academic medicine.

    portable-intubation-video-laryngoscope-usb-500x500

    David Olvera, clinical education manager at Air Methods in Aurora, Colorado said:

    Within my own company, our success rates with video have gone up. This really should be front-line medicine in the prehospital industry.

    A 2016 Cochrane Library review of the evidence concluded that “video laryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway.”

    When Doubt Arises

    But the review did not necessarily reassure manufacturers. The reviewers concluded that the evidence does not show that VL lowers the incidence of hypoxia or time required for intubation. Dr. Jarrod Mosier, associate professor of emergency medicine at the University of Arizona in Tucson, told Medical Expo magazine:

    What we know now is that video is at least as good as direct laryngoscopy most of the time—and sometimes it can be better.

    Medic One’s Dr. Wayne also admits that direct laryngoscopy is sometimes just as good, but that “When you see better, more and can record what you do, you want to use it.”

    Choice of VL for emergency medical services will depend on personal preference, up-front and recurring costs.

    A Tour of the Market

    The following are among the video laryngoscopes currently on the market:

    • The King Vision® video laryngoscope by Ambu uses three AAA alkaline batteries. It features three disposable, channeled blades, one standard disposable blade and a new pediatric blade. The blades are hyperangulated (more info on MedicalExpo.com).
    • GlideScope® by Verathon has a low-profile blade with 60-degree curvature. The hyperangulation helps visualize the glottis in difficult airways, but it requires a specially designed rigid stylet to advance the tracheal tube to the laryngeal inlet. Company product manager Bob Ingram maintained that “The low-profile blades occupy less space in the mouth and make it more comfortable for the patient.” GlideScope also has MAC-style blades, single-use and reusable blades. It offers flexibility for use from neonates to large adults. (more info on MedicalExpo.com).
    • Launched late 2016, Karl Storz Endoscopy’s C-MAC® Pocket Monitor features a 2.4” LCD monitor and power supply that can be attached to a wide range of blades, including adult and pediatric D-blade, MAC 4, 3 and 2, and Miller 2, 1 and 0. According to Michael Lyman, Storz director of sales and marketing, Airway Management, it also offers a monitor with two rotation axes, rechargeable Li-ion batteries and an exchangeable battery pack.

    About the Author

    Laura Newman is a New York-based medical writer that writes frequently about medical technological advances and health policy. She writes for the medical trade press, national health entities, and health care insurers.

    Related Posts

    French echotherapy specialist Theraclion presented its flagship Echopulse device at this year’s...

    Another interesting innovation presented at MEDICA was the GastroPanel quick test. This diagnostic...

    Medisana‘s virtual reality massage chair was a highlight of the 2017 MEDICA trade fair. The...

    Style Switcher

    Highlight Color:

                   

    Backgrounds:

                        

    You can also set your own colors or background from the Admin Panel.