Role of video laryngoscopy in the management of difficult intubations in the emergency department and during prehospital care

Jih-Chang Chen^a, Ming-Hwang Shyr^b

^a Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
^b Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Abstract
Although the advent of emergency medicine as a specialty has led to advances in emergency airway management, airway management is still challenging for emergency physicians. Moreover, patients in need of intubation frequently present in the emergency department (ED) with medical or traumatic conditions that greatly increase the difficulty of managing the airway. In most cases, a direct laryngoscope is used for intubation, and a series of maneuvers are required to directly visualize the vocal cords and place a flexible plastic tube into the trachea. Difficult intubations usually occur with an inadequate glottic view. Operating room studies have shown that video and optical laryngoscopy, in which a miniature video camera enables the operator to visualize the glottis indirectly, improves glottic exposure and the ease of intubation compared with direct laryngoscopy. Video laryngoscopy is becoming more accessible to emergency physicians, yet whether these performance characteristics translate to emergency patients remains unclear. The aim of our article is to provide an up-to-date literature review of video laryngoscopy. We especially focus on learning with mannequins, and clinical performance in normal and difficult airways in the ED and prehospital settings.

Keywords
Airway algorithm; Comack-Lehane scale; Difficult tracheal intubation; Emergency department; Prehospital care