Taxonomy of Laryngoscopy Performance Errors

List of Performance Errors

Errors of Structure Recognition during Laryngoscope Insertion:

Insertion Off Midline Leading to Esophageal Visualization

This error was coded positive when the tip of the blade overran the glottic structures by advancing to either side of the glottic structures and which led to visualizing esophagus

Overly Deep Insertion Leading to Esophageal Visualization

This error was coded when a midline insertion was used, but lack of structure recognition or too rapid an insertion led to overrunning the glottic structures and visualizing esophagus

Missed Anatomical Structure Recognition

This error was coded when the video reviewers were able to identify glottic structures during the laryngoscopy without visualization of esophagus, but the intubator did not recognize these structures as they did not correct tip position to the vallecula or glottic inlet. This error is distinct from the prior two because the intubator did not approach the esophagus

Inadequate Suction

Tube insertion was attempted without adequate structure visualization due to secretions, hemorrhage, or debris and without adequate suctioning

Errors of Vallecula Manipulation

Inadequate Lifting Force

If the tip of the laryngoscope was properly seated in the vallecula indicated by translation of the epiglottis, but inadequate lifting force was applied to expose the glottis sufficiently for bougie or tube passage

Failure to Engage Midline of Vallecula

If the tip of the laryngoscope did not engage the median glossoepiglottic fold resulting in inadequate epiglottic translation

Lost Seating in Vallecula

If during the intubation attempt, loss of vallecular engagement caused loss of glottic visualization

Not Fully Seated in Vallecula

If tip was midline in the vallecula but was not advanced forward sufficiently to cause epiglottic translation

Too Much Force/Over-Insertion at the Vallecula

Over-insertion into the vallecula causing downward movement of the epiglottis and preventing glottic visualization

Errors of Device Delivery

Bougie Delivery Issue

Bougie hung up on anterior tracheal rings without correction or intubator was unable to manipulate bougie through vocal cords

Over-Rotated Insertion

Unable to pass device while the glottis filled > 50% of the screen and cricoid cartilage visualized indicating over-rotation/too-deep an insertion of laryngoscope