Skip to main content Accessibility help

Video Laryngoscopy in the Prehospital Setting

  • Lars P. Bjoernsen (a1) and Bruce Lindsay (a1)


In the prehospital setting, the emergency care provider must anticipate that some patients will manifest with difficult airways. The use of video laryngoscopy to secure an airway in the prehospital setting has not been explored widely, but has the potential to be a useful tool. This article briefly reviews some of the major video laryngoscopes on the market and their usefulness in the prehospital setting. Studies and case reports indicate that the video laryngoscope is a promising device for emergency intubation, and it has been predicted that, in the future, video laryngoscopy will dominate the field of emergency airway management.

Direct laryngoscopy always should be retained as a primary skill; however, the video laryngoscope has the potential to be a good primary choice for the patient with potential cervical spine injuries or limited jaw or spine mobility, and in the difficult-to-access patient.The role of video laryngoscopes in securing an airway in head and neck trauma victims in the prehospital setting has yet to be determined, but offers interesting possibilities. Further clinical studies are necessary to evaluate its role in airway management by prehospital emergency medical services.


Corresponding author

Flight Physician and Medical DirectorUniversity of Wisconsin Med FlightE5/768 CSC, 600 Highland AvenueMadison, Wisconsin 53792-3284USA E-mail:


Hide All
1.Sakles, JC, Rodgers, R, Keim, SM: Optical and video laryngoscopes for emergency airway management. Intern Emerg Med 2008;3(2):139143.
2.Gerich, TG, Schmidt, U, Hubrich, V, Lobenhoffer, HP, Tscherne, H: Prehospital airway management in the acutely injured patient: The role of surgical cricothyrotomy revisited. J Trauma 1998;45(2):312314.
3.Adnet, F, Jouriles, NJ, Le Toumelin, P, Hennequin, B, Taillandier, C, Rayeh, F, Couvreur, J, Nougiere, B, Nadiras, P, Ladka, A, Fleury, M: Survey of out-ofhospital emergency intubations in the French prehospital medical system: A multicenter study. Ann Emerg Med 1998;32(4):454460.
4.American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003;98(5):12691277.
5.Nolan, JP, Wilson, ME:Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia 1993;48(7):630633.
6.Hastings, RH, Wood, PR: Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology 1994;80(4):825831.
7.Huang, WT, Huang, CY, Chung, YT: Clinical comparisons between GlideScope video laryngoscope and Trachlight in simulated cervical spine instability. J Clin Anesth 2007;19(2):110114.
8.Heath, KJ: The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia 1994;49(10):843845.
9.Combes, X, Jabre, P, Jbeili, C, Leroux, B, Bastuji-Garin, S, Margenet, A, Adnet, F, Dhonneur, G: Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad Emerg Med 2006;13(8):828834.
10.Hastings, RH, Marks, JD: Airway management for trauma patients with potential cervical spine injuries. Anesth Analg 1991;73(4):471482.
11.Sawin, PD, Todd, MM, Traynelis, VC, Farrell, SB, Nader, A, Sato, Y, Clausen, JD, Goel, VK: Cervical spine motion with direct laryngoscopy and orotracheal intubation.An in vivo cinefluoroscopic study of subjects without cervical abnormality. Anesthesiology 1996;85(1):2636.
12.Lam, AM: Acute spinal cord ischemia: Implications for Anesthetic Management. In Stoeltin, RK (ed), Advances in Anesthesia. St. Louis: Mosby Year Book 10, 1993, pp 247273.
13.Kaplan, MB, Berci, G: Videolaryngoscopy in the management of the difficult airway. Can J Anaesth 2004;51(1):94; author reply 95–96.
14.Hagberg, C, Vogt-Harenkamp, CC, Bogomolny, Y, Ellis, S, Nguyen, TV: A comparison of laryngoscopy techniques using the video laryngoscope and the traditional Macintosh laryngoscope in potentially difficult to intubate patients. Anesth Analg 2005;100:s212.
15.Hagberg, CA, Vogt-Harenkamp, CC, Iannucci, DG: Successful airway management of a patient with a known difficult airway with the Direct Coupler Interface Video Laryngoscope. J Clin Anesth 2007;19(8):629631.
16.Weiss, M, Schwarz, U, Dillier, CM, Gerber, AC: Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy. Paediatr Anaesth 2001;11(3):343348.
17.Bjoernsen, LP, Parquett, B, Lindsey, B: Prehospital use of video laryngoscope by an air medical crew. Air Medical Journal 2008;27(5):242244.
18.Cooper, RM: Use of a new videolaryngoscope (GlideScope) in the management of a difficult airway. Can J Anaesth 2003;50(6):611613.
19.Doyle, DJ, Zura, A, Ramachandran, M: Videolaryngoscopy in the management of the difficult airway. Can J Anaesth 2004;51(1):95; author reply 95–96.
20.Agro, F, Barzoi, G, Montecchia, F: Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth 2003;90(5):705706.
21.Cooper, RM, Pacey, JA, Bishop, MJ, McCluskey, SA: Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005;52(2):191198.
22.Shippey, B, Ray, D, McKeown, D: Case series: The McGrath videolaryngoscope–An initial clinical evaluation. Can J Anaesth 2007;54(4):307313.
23.Shippey, B, Ray, D, McKeown, D: (2008) Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation. Br J Anaesth 2008;100(1):116119.
24.Kagawa, T: [Pediatric airway management: cuffed endotracheal tube and other devices for tracheal intubation”. Masui 2007;56(5):534541. [in Japanese].
25.Suzuki, A, Hayashi, D, Toyama, H, Minami, S, Iwasaki, H: [Use of the pentax-AWS in a patient with Cormack 3a difficult airway]. Masui 2007;56(3):341344. [in Japanese].
26.Suzuki, A, Toyama, Y, Katsumi, N, Sasaki, R, Hirota, K, Matsumoto, H, Takahata, O, Iwasaki, H: [Pentax-AWS improves laryngeal view compared with Macintosh blade during laryngoscopy and facilitates easier intubation]. Masui 2007;56(4):464468. [in Japanese].
27.Dhonneur, G, Ndoko, S, Amathieu, R, Housseini, LE, Poncelet, C, Tual, L: Tracheal intubation using the Airtraq in morbid obese patients undergoing emergency cesarean delivery. Anesthesiology 2007;106(3):629630.
28.Maharaj, CH, Costello, J, Higgins, BD, Harte, BH, Laffey, JG: Retention of tracheal intubation skills by novice personnel: A comparison of the Airtraq and Macintosh laryngoscopes. Anaesthesia 2007;62(3):272278.
29.Maharaj, CH, Costello, JF, Higgins, BD, Harte, BH, Laffey, JG: Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia 2006;61(7):671677.
30.Maharaj, CH, Costello, JF, McDonnell, JG, Harte, BH, Laffey, JG.The Airtraq as a rescue airway device following failed direct laryngoscopy: A case series. Anaesthesia 2007;62(6):598601.
31.Maharaj, CH, Higgins, BD, Harte, BH, Laffey, JG: Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy–A manikin study. Anaesthesia 2006;61(5):469477.
32.Maharaj, CH, Ni Chonghaile, M, Higgins, BD, Harte, BH, Laffey, JG: Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes–A manikin study. Am J Emerg Med 2006;24(7):769774.
33.Maharaj, CH, O'Croinin, D, Curley, G, Harte, BH, Laffey, JG: A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial. Anaesthesia 2006;61(11):10931099.
34.Norman, A, Date, A: Use of the Airtraq laryngoscope for anticipated difficult laryngoscopy. Anaesthesia 2007;62(5):533534.
35.Suzuki, A, Toyama, Y, Iwasaki, H, Henderson, J: Airtraq for awake tracheal intubation. Anaesthesia 2007;62(7):746747.
36.Maharaj, CH, Costello, JF, Higgins, BD, Harte, BH, Laffey, JG: Learning and performance of tracheal intubation by novice personnel: A comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia 2006;61(7):671677.
37.Hung, O, Murphy, M: Unanticipated difficult intubation. Curr Opin Anaesthesiol 2004;17(6):479481.
38.Liu, EH, Poon, KH, Ng, BS, Goh, EY, Goy, RW: The Airway Scope, a new video laryngoscope: its use in three patients with cervical spine problems. Br J Anaesth 2008;100(1):142143.
39.Lai, HY, Chen, IH, Chen, A, Hwang, FY, Lee, Y: The use of the GlideScope for tracheal intubation in patients with ankylosing spondylitis. Br J Anaesth 2006;97(3):419422.
40.Henderson, J, Popat, M, Latto, P, Pearce, A: Difficult Airway Society guidelines. Anaesthesia 2004;59:12421243; author reply 1247.
41.Robitaille, A, Williams, SR, Tremblay, MH, Guilbert, F, Theriault, M, Drolet, P: Cervical spine motion during tracheal intubation with manual in-line stabilization: Direct laryngoscopy versus GlideScope videolaryngoscopy. Anesth Analg 2008;106(3):935941, table of contents.
42.Hirabayashi, Y, Fujita, A, Seo, N, Sugimoto, H: Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh laryngoscope. Anaesthesia 2007;62(10):10501052.
43.Turkstra, TP, Craen, RA, Pelz, DM, Gelb, AW: Cervical spine motion: A fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg 2005;101(3):910915.
44.Sun, DA, Warriner, CB, Parsons, DG, Klein, R, Umedaly, HS, Moult, M: The GlideScope Video Laryngoscope: Randomized clinical trial in 200 patients. Br J Anaesth 2005;94(3):381384.
45.Maruyama, K, Yamada, T, Kawakami, R, Kamata, T, Yokochi, M, Hara, K: Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope. Br J Anaesth 2008;100(1):120124.
46.McClelland, SH, McCahon, RA, Norris, AM: Cervical spine movement using the Airway Scope. Anaesthesia 2008;63(2):207208; author reply 208-209.
47.Maharaj, CH, Buckley, E, Harte, BH, Laffey, JG: Endotracheal intubation in patients with cervical spine immobilization: A comparison of Macintosh and Airtraq laryngoscopes. Anesthesiology 2007;107(1):5359.
48.Maharaj, CH, Costello, J, Higgins, BD, Harte, BH, Laffey, JG: Retention of tracheal intubation skills by novice personnel: A comparison of the Airtraq and Macintosh laryngoscopes. Anaesthesia 2007;62(3):272678.
49.Maharaj, CH, Costello, JF, Harte, BH, Laffey, JG: Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia 2008;63(2):182188.
50.Byhahn, C, Meininger, D, Walcher, F, Hofstetter, C, Zwissler, B: Prehospital emergency endotracheal intubation using the Bonfils intubation fiberscope. Eur J Emerg Med 2007;14(1):4346.
51.Mencke, T, Echternach, M, Kleinschmidt, S, Lux, P, Barth, V, Plinkert, PK, Fuchs-Buder, T: Laryngeal morbidity and quality of tracheal intubation: A randomized controlled trial. Anesthesiology 2003;98(5):10491056.
52.Rai, MR, Dering, A, Verghese, C: The Glidescope system: A clinical assessment of performance. Anaesthesia 2005;60(1):6064.
53.Murrell, GL, Sandberg, KM, Murrell, SA: GlideScope video laryngoscopes. Otolaryngol Head Neck Surg 2007;136(2):307308.
54.Benjamin, FJ, Boon, D, French, RA: An evaluation of the GlideScope, a new video laryngoscope for difficult airways: a manikin study. Eur J Anaesthesiol 2006;23(6):517521.
55.Hsiao, WT, Lin, YH, Wu, HS, Chen, CL: Does a new videolaryngoscope (Glidescope) provide better glottic exposure? Acta Anaesthesiol Taiwan 2005;43(3):147151.
56.Asai, T, Enomoto, Y, Okuda, Y: Airway Scope for difficult intubation. Anaesthesia 2007;62(2):199.
57.Koyama, Y, Inagawa, G, Miyashita, T, Kikuchi, T, Miura, N, Miki, T, Kurihara, R, Kamiya, Y, Goto, T: Comparison of the Airway Scope, gum elastic bougie and fibreoptic bronchoscope in simulated difficult tracheal intubation: A manikin study. Anaesthesia 2007;62(9):936939.
58.Miki, T, Inagawa, G, Kikuchi, T, Koyama, Y, Goto, T: Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: A manikin study. Acta Anaesthesiol Scand 2007;51(10):13781381.
59.Lim, TJ, Lim, Y, Liu, EH: Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy. Anaesthesia 2005;60(2):180183.
60.Hirabayashi, Y, Hakozaki, T, Fujisawa, K, Sata, N, Kataoka, S, Okada, O, Yamada, M, Hotta, K, Seo, N, Ikeda, K: [Use of a new video-laryngoscope (GlideScope) in patients with a difficult airway]. Masui 2007;56(7):854857. [in Japanese].
61.Gooden, CK: Successful first time use of the portable GlideScope videolaryngoscope in a patient with severe ankylosing spondylitis. Can J Anaesth 2005;52(7):777778.
62.Hirabayashi, Y, Hakozaki, T, Fujisawa, K, Yamada, M, Suzuki, H, Satoh, M, Hotta, K, Igarashi, T, Taga, N, Seo, N: [The GlideScope videolaryngoscope: A clinical assessment of its performance in consecutive 200 patients]. Masui 2007;56(9):10591064. [in Japanese].
63.Xue, FS, Zhang, GH, Li, XY, Sun, HT, Li, P, Li, CW, Liu, KP: Comparison of hemodynamic responses to orotracheal intubation with the GlideScope videolaryngoscope and the Macintosh direct laryngoscope. J Clin Anesth 2007;19(4):245250.
64.Cooper, RM: Complications associated with the use of the GlideScope videolaryngoscope. Can J Anaesth 2007;54(1):5457.
65.Cross, P, Cytryn, J, Cheng, KK: Perforation of the soft palate using the GlideScope videolaryngoscope. Can J Anaesth 2007;54(7):588589.
66.Hsu, WT, Hsu, SC, Lee, YL, Huang, JS, Chen, CL: Penetrating injury of the soft palate during GlideScope intubation. Anesth Analg 2007;104(6):16091610; discussion 1611.
67.Malik, AM, Frogel, JK: Anterior tonsillar pillar perforation during GlideScope video laryngoscopy. Anesth Analg 2007;104(6):16101611; discussion 1611.
68.Chin, KJ, Arango, MF, Paez, AF, Turkstra, TP: Palatal injury associated with the GlideScope. Anaesth Intensive Care 2007;35(3):449450.
69.Braude, D, Richards, M: Rapid Sequence Airway (RSA)—A novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250252.
70.Marrel, J, Blanc, C, Frascarolo, P, Magnusson, L: (2007) Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesthesiol 2007;24(12):10451049.
71.Milne, AD, Dower, AM, Hackmann, T: Airway management using the pediatric GlideScope in a child with Goldenhar syndrome and atypical plasma cholinesterase. Paediatr Anaesth 2007;17(5):484487.
72.Trevisanuto, D, Fornaro, E, Verghese, C: The GlideScope video laryngoscope: initial experience in five neonates. Can J Anaesth 2006;53(4):423424.
73.Samuels, J, Brody, R: (Planned start April 2008). Comparison Study in Adult Surgical Patients of 5 Airway Devices (Prospective, Randomized Comparison of Intubating Conditions With Airtraq Optical, Storz DCI Video, McGRATH Video, GlideScope Video, & Macintosh Laryngoscope in Randomly Selected Elective Adult Surgical Patients). Weill Medical College of Cornell identifier: NCT00602979.


Related content

Powered by UNSILO

Video Laryngoscopy in the Prehospital Setting

  • Lars P. Bjoernsen (a1) and Bruce Lindsay (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.