A pilot, prospective, randomized trial of video versus direct laryngoscopy for paramedic endotracheal intubation.

BACKGROUND: Prehospital intubation poses several unique challenges. Video assisted laryngoscopy has been shown to help increase intubation success in the hospital setting; however, little prospective data have examined video assisted laryngoscopy in traditional ground ambulance agencies. METHODS: We performed a randomized, cross-over, non-blinded trial in ground ambulances comparing first attempt success and overall intubation success between video assisted laryngoscopy using the King Video Laryngoscope (KVL) and direct laryngoscopy (DL). We collected patient and provider demographics along with intubation details. Success rates were compared on a per-protocol and an intention-to-treat analysis. RESULTS: Over 34 months, a total of 82 intubations were performed with 42 DL and 40 KVL based on the intention-to-treat analysis. First attempt success (28/42, 66.7% vs 25/40, 62.5%, p=0.69) and overall success (34/42, 81% vs 29/40, 72.5%, p=0.37) were similar between DL and KVL. Cormack-Lehane view and percentage of glottic opening were similar between devices. These results were consistent in the per-protocol analysis. CONCLUSIONS: In our study utilizing two ground EMS agencies, video assisted laryngoscopy with the KVL had similar first attempt success rates to direct laryngoscopy.

Diamond-Blackfan anemia and nutritional deficiency-induced anemia in children.

Diamond-Blackfan anemia is a rare, inherited disease that characteristically presents as a chronic, normochromic macrocytosis due to red cell lineage bone marrow failure. Although studies are elaborating on the genetic basis for its associated comorbidities, little has been published comparing this anemia to other chronic anemias that have similar laboratory results in children. This article offers a global perspective of the disease and compares it with anemia due to vitamin B12 and folate deficiency in children.