Videoscopes: an additional tool for managing the pre-hospital airway

Airway management in the pre-hospital field has in recent years attracted an array of interest and the debate surrounding paramedic led endotracheal intubation is ever evolving. It is recognised that paramedics are the principal providers of out of hospital, unscheduled emergency care, and as such, it is the responsibility of all paramedics to be able to recognise, intervene and manage a patient's airway as appropriate. This short report will examine the emerging pre-hospital application of video-based laryngoscopes, giving consideration to how these devices may be incorporated into the paramedic airway armoury, and how they compare to the conventional laryngoscope, currently utilised by the majority of UK ambulance services. Throughout this report, the term videoscope is utilised to describe all available video based laryngoscopes.

Through reviewing current literature, it is evident that sub-optimal conditions for tracheal intubation in the pre-hospital setting occur in 7–10% of patients, with studies showing unrecognised failed intubations of up to 3% in cardiac arrest patients (Bjoernsen and Lindsay, 2009; Wayne and McDonnell, 2010; Butchart et al, 2011). Furthermore, difficult intubation is defined as an operator requiring more than one attempt to gain a view of the larynx and place a cuffed tube in the trachea (Bjoernsen and Lindsay, 2009). The incidence of difficult intubations encountered by paramedics is not widely reported within the literature; however, it must be considered that this would reflect the figures highlighted in which sub-optimal conditions occur. Hodkinson (2010) recognises that skill fade in intubation occurs in paramedics due to lack of clinical exposure and wide variations in initial training. With this in mind, it is imperative that paramedics are equipped with the knowledge, skills and ability to manage any airway that is encountered in the pre-hospital field.