Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study
Introduction: Upright intubation is essential for managing difficult airways but can be challenging, especially for less experienced clinicians. Face-to-face intubation may lower first-pass success rates due to unfamiliar orientation. New videolaryngoscope devices have the potential to improve intub...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2025-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/4348h9nb |
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| author | Cheng-Wei Tseng Chung-Shiung Wen Sheng-Han Yu Yung-Cheng Su Shu-Sheng Li Hsin-Ling Chen Tzu-Yao Hung |
| author_facet | Cheng-Wei Tseng Chung-Shiung Wen Sheng-Han Yu Yung-Cheng Su Shu-Sheng Li Hsin-Ling Chen Tzu-Yao Hung |
| author_sort | Cheng-Wei Tseng |
| collection | DOAJ |
| description | Introduction: Upright intubation is essential for managing difficult airways but can be challenging, especially for less experienced clinicians. Face-to-face intubation may lower first-pass success rates due to unfamiliar orientation. New videolaryngoscope devices have the potential to improve intubation success. We aimed to compare first-pass success rates, intubation duration, and glottic view between the right-rear and face-to-face approaches, using channeled videolaryngoscope, hyperangulated videolaryngoscope, and video stylet for upright intubation. Methods: We conducted a cross-over manikin simulation study involving 30 participants—19 attending physicians, six residents, and five nurse practitioners—to compare the efficacy of these devices to a standard Macintosh videolaryngoscope, using both right-rear and face-to-face approaches. Results: We used Cox regression analysis to calculate hazard ratios for the following variables: first-pass success rate; intubation time; glottic view quality (Cormack-Lehane grade [C-L]); and percentage of glottis opening score (POGO]. The right-rear approach demonstrated a substantial improvement in first-pass success rates compared to face-to-face, with rates of 93% vs 78% and a hazard ratio of 2.10 (95% confidence interval 1.58–2.80). Additionally, both the video stylet and channeled videolaryngoscope techniques further optimized first-pass success rates and enhanced glottic visualization, achieving a CL grade I view and POGO scores of 100%, even in the inverted face-to-face orientation. These devices outperformed the standard Macintosh and hyperangulated videolaryngoscopes. Conclusion: The right-rear approach was associated with higher first-pass success rates and provided a more familiar orientation for operators during upright intubation. Video stylets and channeled videolaryngoscopes also contributed to improved success rates, shorter intubation times, and better glottic visualization. |
| format | Article |
| id | doaj-art-46ac0d26bb2440fabfa58617455b7c4b |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-46ac0d26bb2440fabfa58617455b7c4b2025-08-20T03:41:19ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-07-012641086109410.5811/westjem.39983wjem-26-1086Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin StudyCheng-Wei Tseng0Chung-Shiung Wen1Sheng-Han Yu2Yung-Cheng Su3Shu-Sheng Li4Hsin-Ling Chen5Tzu-Yao Hung6Taipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, TaiwanTaipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, TaiwanTaipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, TaiwanChiayi Christian Hospital, Ditmanson Medical Foundation, Department of Emergency, Chiayi County, TaiwanTaipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, TaiwanTaipei City Hospital, Zhong-Xing Branch, Department of Emergency Medicine, Taipei City, TaiwanCrazyatLAB (Critical Airway Training Laboratory), Taipei City, TaiwanIntroduction: Upright intubation is essential for managing difficult airways but can be challenging, especially for less experienced clinicians. Face-to-face intubation may lower first-pass success rates due to unfamiliar orientation. New videolaryngoscope devices have the potential to improve intubation success. We aimed to compare first-pass success rates, intubation duration, and glottic view between the right-rear and face-to-face approaches, using channeled videolaryngoscope, hyperangulated videolaryngoscope, and video stylet for upright intubation. Methods: We conducted a cross-over manikin simulation study involving 30 participants—19 attending physicians, six residents, and five nurse practitioners—to compare the efficacy of these devices to a standard Macintosh videolaryngoscope, using both right-rear and face-to-face approaches. Results: We used Cox regression analysis to calculate hazard ratios for the following variables: first-pass success rate; intubation time; glottic view quality (Cormack-Lehane grade [C-L]); and percentage of glottis opening score (POGO]. The right-rear approach demonstrated a substantial improvement in first-pass success rates compared to face-to-face, with rates of 93% vs 78% and a hazard ratio of 2.10 (95% confidence interval 1.58–2.80). Additionally, both the video stylet and channeled videolaryngoscope techniques further optimized first-pass success rates and enhanced glottic visualization, achieving a CL grade I view and POGO scores of 100%, even in the inverted face-to-face orientation. These devices outperformed the standard Macintosh and hyperangulated videolaryngoscopes. Conclusion: The right-rear approach was associated with higher first-pass success rates and provided a more familiar orientation for operators during upright intubation. Video stylets and channeled videolaryngoscopes also contributed to improved success rates, shorter intubation times, and better glottic visualization.https://escholarship.org/uc/item/4348h9nb |
| spellingShingle | Cheng-Wei Tseng Chung-Shiung Wen Sheng-Han Yu Yung-Cheng Su Shu-Sheng Li Hsin-Ling Chen Tzu-Yao Hung Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study Western Journal of Emergency Medicine |
| title | Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study |
| title_full | Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study |
| title_fullStr | Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study |
| title_full_unstemmed | Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study |
| title_short | Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study |
| title_sort | comparative efficacy of face to face and right rear upright intubation in a randomized crossover manikin study |
| url | https://escholarship.org/uc/item/4348h9nb |
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