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Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project
  1. Alistair Steel1,2,
  2. Charlotte Haldane1,3,
  3. Dan Cody1,4
  1. 1 Magpas Air Ambulance, Huntingdon, Cambridgeshire, UK
  2. 2 Department of Anaesthesia, Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
  3. 3 North West Air Ambulance, Knowsley, UK
  4. 4 South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
  1. Correspondence to Dr Alistair Steel, Magpas Air Ambulance, Huntingdon, Cambridgeshire, UK; alistair.steel{at}


Introduction Advanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting.

Methods An East of England physician–paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016–2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team’s views of VL introduction.

Results 919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments.

Conclusion Despite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.

  • airway
  • pre-hospital

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  • Handling editor Caroline Leech

  • Twitter @alistairsteel

  • Contributors All authors assisted with the project and in preparation of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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