EGRI scoring predicts difficult laryngoscopy and tracheal intubation with King Vision video laryngoscope: Study

Airway management plays a crucial role in anesthesiology, and anticipating and handling challenging intubations is essential for patient safety. Difficult airway situations are a major contributing factor to anesthesia-related fatalities, with the El-Ganzouri risk index (EGRI) being designed to predict difficult intubations by considering various clinical factors like mouth opening, thyromental distance, and Mallampati classification. Recent study evaluated the predictive efficacy of El-Ganzouri risk index (EGRI) scoring for difficult laryngoscopy and tracheal intubation using the King Vision™ video laryngoscope. Airway assessment was conducted pre-induction using EGRI score, and final laryngoscopy and intubation were performed using the King Vision™ video laryngoscope, with outcomes assessed using the Percentage of Glottic Opening (POGO), Fremantle scores, and the modified Intubation Difficulty Scale. A total of 250 patients were included, and the optimal cut-off value for EGRI score was found to be 3. The study found that EGRI scoring effectively predicted difficult laryngoscopy and tracheal intubation with the King Vision™ video laryngoscope, with sensitivity, specificity, and area under the curve (AUC) of 82%, 86%, and 0.9 for the POGO score and 74%, 92%, and 0.85 for the Fremantle score. The ease of tube placement, when assessed using a modified Intubation Difficulty Scale, had a sensitivity, specificity, and AUC of 95%, 86%, and 0.94, respectively.

Association of EGRI Scores and Difficult Tracheal Intubation

The EGRI score was determined preoperatively for each patient, with scores of 4 or higher indicating a high risk for difficult airway management. The study demonstrated a significant association between EGRI scores and various demographic and clinical parameters, as well as its utility in forecasting difficult tracheal intubation, particularly when measured by the Intubation Difficulty Scale. The findings indicated that EGRI scoring effectively predicted difficult laryngoscopy and tracheal intubation with the King Vision™ video laryngoscope, especially in comparison to other scoring systems. However, the study also identified a discrepancy between obtaining a good laryngoscopic view and achieving easy tracheal intubation, highlighting the need for standardized prediction systems for video laryngoscopes.

Strengths and Limitations of the Study

The study's strengths included its prospective design, systematic use of multiple validated scoring systems, and the implication that EGRI effectively predicts difficult airways in patients intubated with King Vision™ VL. However, the study has some limitations including single-center nature, observational design, and absence of a control group using alternative video laryngoscopes, which should be considered in future research. Overall, the study concluded that EGRI scoring can effectively predict difficult laryngoscopy and tracheal intubation with the King Vision™ video laryngoscope, as demonstrated through the statistical analyses and comparison to other scoring systems.

Key Points

- The study aimed to evaluate the predictive efficacy of the El-Ganzouri risk index (EGRI) scoring for difficult laryngoscopy and tracheal intubation using the King Vision™ video laryngoscope. This involved conducting airway assessments pre-induction using EGRI scores and performing final laryngoscopy and intubation with outcomes assessed using the Percentage of Glottic Opening (POGO) score, Fremantle scores, and the modified Intubation Difficulty Scale.

- The study included 250 patients and found that the optimal cut-off value for the EGRI score was 3. The researchers determined that EGRI scoring effectively predicted difficult laryngoscopy and tracheal intubation with the King Vision™ video laryngoscope, with sensitivity, specificity, and area under the curve (AUC) of 82%, 86%, and 0.9 for the POGO score, 74%, 92%, and 0.85 for the Fremantle score, and 95%, 86%, and 0.94 for the modified Intubation Difficulty Scale.

- The association of EGRI scores and difficult tracheal intubation was assessed, with scores of 4 or higher indicating a high risk for difficult airway management. The findings indicated a significant association between EGRI scores and various demographic and clinical parameters, as well as its utility in forecasting difficult tracheal intubation, particularly when measured by the Intubation Difficulty Scale. - The study highlighted strengths such as its prospective design, systematic use of multiple validated scoring systems, and implications that EGRI effectively predicts difficult airways in patients intubated with the King Vision™ VL. However, it also noted limitations including the single-center nature, observational design, and absence of a control group using alternative video laryngoscopes, which should be considered in future research.

- Overall, the study concluded that EGRI scoring can effectively predict difficult laryngoscopy and tracheal intubation with the King Vision™ video laryngoscope, as demonstrated through statistical analyses and comparison to other scoring systems.

- The study emphasized the importance of standardized prediction systems for video laryngoscopes and highlighted the need for future research to address the identified limitations, including the single-center nature and absence of a control group using alternative video laryngoscopes.

Reference –

Baby AE, D’souza MC, Krishnakumar M, Kavalakkatt DD. Evaluating the predictive efficacy of the El‑Ganzouri risk index for difficult laryngoscopy and intubation with King Vision™ video laryngoscope: A prospective cohort study. Indian J Anaesth 2024;68:1003‑9