Trial reportThe western journal of emergency medicine2025
Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study.
Trial report in The western journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionUpright 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.
methodsWe 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.
resultsWe 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.
conclusionThe 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.
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