Video laryngoscopes.

Why was this topic appraised?

Emergency services are required to respond to situations where patients are having difficulty breathing and airway management in the pre-hospital setting is needed.

These are usually situations when there has been either major trauma or cardiac arrest. In some cases, airway management be safely accomplished using basic airway techniques, such as the use of a supraglottic airway, that may provide temporary provision of oxygenation and ventilation. However, in more severe cases, for example following major trauma, the introduction of a breathing tube into the trachea (pre-hospital intubation) is required to ensure that the patient can be safely
transferred to hospital. When intubation is needed, it is acknowledged that ensuring that this is successfully achieved without complications and at the earliest opportunity is a high clinical priority.

During intubation, visualisation of the upper airway (larynx) to allow passage of the tracheal tube is achieved using laryngoscopy. This is usually done using a rigid tool that shines a light into the larynx to provide direct sight of the vocal cords (direct laryngoscopy). However, this can also be achieved using a more flexible device that has a camera incorporated (video laryngoscopy), which relays real-time images onto a display screen. It has been suggested the use of video laryngoscopy in a pre-hospital setting may be associated with higher rates of intubation success and improved patient care.
HTW considered this topic after it was proposed by the Welsh Ambulance Services NHS Trust.