• Dhimitri A Nikolla, Jestin N Carlson, Paul M Jimenez Stuart, Irtaza Asar, Michael D April, Amy H Kaji, and Calvin A Brown.
• Department of Emergency Medicine, Allegheny Health Network - Saint Vincent, Erie, PA, United States of America. Electronic address: dhimitri.nikolla@med.lecom.edu.
• Am J Emerg Med. 2022 Jul 1; 57: 47-53.

IntroductionLaryngoscope blade shape may differentially facilitate first-attempt success in patients intubated in non-supine positions in the emergency department (ED). Therefore, we analyzed first-attempt success in ramped and upright positions stratified by hyperangulated or standard geometry video laryngoscopes (VL).MethodsWe performed a secondary analysis of the National Emergency Airway Registry (NEAR) on ED intubations from January 1, 2016 to December 31, 2018. Our primary outcome was first-attempt success, and secondary outcomes included first-attempt success without adverse events and glottic view. We included all VL intubation attempts in the ramped and upright positions on medical patients >17-years-old. We calculated adjusted odds ratios (aOR) using a multivariable logistic regression mixed-effects model with site as a random effect and blade type, obesity / morbid obesity, training level (i.e., post-graduate year), operator-perceived difficult airway, and presence of an objective difficult airway finding as fixed effects.ResultsOur analysis included 266 attempts with hyperangulated blades and 370 attempts with standard geometry blades in the ramped cohort, and 116 attempts with hyperangulated attempts and 55 attempts with standard geometry blades in the upright cohort. In the ramped cohort, 244 (91.7%) of hyperangulated first attempts were successful, and 341 (92.2%) of standard geometry first attempts were successful (aOR 1.02 [95% confidence interval 0.56, 1.84]). In the upright cohort, 107 (92.2%) of hyperangulated first attempts were successful, and 50 (90.9%) of standard geometry first attempts were successful (aOR 1.04 [0.28, 3.86]). There was no difference across the secondary outcomes, including first-attempt success without adverse events.ConclusionHyperangulated and standard geometry VL had similar first-attempt success in ramped and upright position intubations in the ED.Copyright © 2022 Elsevier Inc. All rights reserved.

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