Hyperangulated Video Laryngoscopy in the Emergency Department: An Analysis of Errors and Factors Leading to Prolonged Apnea Time
Amelia Bryan, Jordan Feltes, Peter William Sweetser, Samuel Winsten, Ian Hunter, David Yamane
American Journal of Emergency Medicine, May 19, 2025
✅ Conclusions:
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Most errors stem from improper blade positioning and challenges with anterior ETT delivery.
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Educational interventions should focus on:
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Optimizing patient positioning
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Stylet shaping
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Hand positioning techniques
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Targeted training could reduce errors and minimize prolonged apnea time, enhancing patient safety.
🧪 Methods:
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Design: Retrospective observational study
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Setting: Single academic ED
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Sample: 101 hyperangulated VL intubations performed by EM residents
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Video Review: Two reviewers + third-party adjudication
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Metrics Evaluated:
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View grade
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Time to vocal cord visualization
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Time to tube delivery
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Specific procedural errors (blade placement, tube delivery, suction use)
📊 Key Results:
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First pass success rate: 84.9%
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Median time to view cords: 7 seconds (IQR 5–11)
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Median time to deliver tube: 26 seconds (IQR 20.75–43)
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At least one error noted in: 67% of successful intubations
🔻 Most Common Errors:
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Blade placement errors: 43.8%
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Difficulty with tube delivery: 39.6%
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Suction-related errors:
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Unnecessary suctioning: 35.7%
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Failure to suction when needed: 9.0%
Bryan, A., Feltes, J., Sweetser, P.W., Winsten, S., Hunter, I. and Yamane, D., 2025. Hyperangulated video laryngoscopy in the emergency department: An analysis of errors and factors leading to prolonged apnea time. The American Journal of Emergency Medicine.