Improving Emergency Airway Care at a Critical Access Hospital

Abstract

Emergency airway care is of the highest priority in caring for patients arriving at the emergency department with critical injuries and conditions. Intubation via laryngoscopy is the gold standard for placing an endotracheal tube to manage ventilation. In rural areas, emergency airway care is often the responsibility of non-expert providers who rarely have the opportunity to perform this life-saving procedure. These less experienced providers often take a longer time and make more attempts at endotracheal intubation. Multiple attempts and increased time taken to secure an airway are associated with higher morbidity and mortality. A critical review of the literature supports that video laryngoscopy increases first pass endotracheal intubation success. Video laryngoscopy is associated with faster intubation times and an improved view of glottic structures. This evidence-based quality improvement project implemented training and simulation in the use of video laryngoscopy for non-expert providers. After implementation of this quality improvement project, findings demonstrated an improved confidence with use of video laryngoscopy, increased confidence that video laryngoscopy is associated with improved visualization of glottic area and increased confidence associated with first pass of the endotracheal tube in non-expert providers using laryngoscopy to perform endotracheal intubation.