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Emergency intubation of infants: does laryngoscope blade design make any difference?
  1. J D Whittaker,
  2. C Moulton
  1. Accident and Emergency Department, Royal Bolton Hospital.


    OBJECTIVE: To compare intubation times and ease of use for a range of infant laryngoscope blades in the hands of accident and emergency (A&E) personnel. METHODS: Seven different blades were compared in terms of intubation times and ease of use scores in the hands of 30 A&E senior house officers (SHOs) and nurses using a standard infant manikin. RESULTS: There was a significant difference in intubation times between the seven blades (p < 0.001). Intubation with two blade designs (Seward and Soper) took almost twice as long as for the other blades (p < 0.05). Subjective ease of use scoring also identified the Seward and Soper blades as being the most difficult to use (p < 0.05). There were no significant differences between SHO and nurse intubation times or ease of use scoring. Successful intubation was achieved within 30 seconds in 90% of attempts. All but two of the subjects used an incorrect levering technique for intubation despite all having previously received training in infant intubation. CONCLUSIONS: No current standard exists regarding the utilisation of infant laryngoscope blades in the A&E department. The first line blade available should be a C shaped blade (Miller, Oxford, Robert-shaw, or Wisconsin). Other blade designs should be kept for use only by more experienced personnel or in difficult intubation situations. Intubation training must focus on correct technique and regular assessment is essential.

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