Check out this paper in the upcoming Annals of EM. Data from the Videography in Pediatric Resuscitation (VIPER) Collaborative. Not a huge number of patients (494), but a solid N for a pediatric airway paper.

Research Pearl: Never just read the abstract, at least also look at the tables and figures! Then of course when you write a paper (or even an abstract), spend tons of time on your tables and figures, they are often the most efficient way to convey your findings to the reader.

Much of their findings are of course applicable to adult airway. Some interesting stats:

– The first-attempt success rate was 67%

– Median laryngoscopy duration 35 seconds (interquartile range 25 to 40)

– Hypoxemia occurred in 15% of the patients.

– Videolaryngoscopy was used for at least a part of the procedure in 48% of the attempts, and it had no association with success or the incidence of hypoxemia.

– Intubation attempts longer than 45 seconds had a greater incidence of hypoxemia (29% versus 6%). Furthermore, apneic oxygenation was used in 8% of the first attempts.

***What is happening? Why do we not set up apneic oxygenation on everyone? They had two of the 18 people (11%) with apneic O2 desat, but 18% of those with no apneic O2. Of course 18 is a tiny number and we can’t draw any conclusions, but there is no reason not to throw a nasal cannula (>15L) on every patient you intubate.

Take a look at Table 1 (pasted below), impressive intubation success for EM residents.

First-attempt success by provider category
Pediatric resident	1/1 (100%)	2/4 (50%)	3/12 (25%)	1/1 (100%)
EM resident	28/36 (79%)	7/9 (78%)	5/7 (71%)	7/10 (70%)
PEM fellow	61/112 (55%)	52/68 (76%)	12/20 (60%)	77/98 (79%)
PEM attending	7/11 (64%)	3/5 (60%)	0/3 (0%)	7/11 (64%)
PCCM fellow	13/15 (87%)	3/7 (43%)	NA	NA
Anesthesia	15/19 (78%)	17/22 (78%)	4/5 (80%)	7/9 (78%)
Other	NA	NA	NA	6/10 (60%)

Ok that’s probably enough for one post, check out the paper.