• A taxonomy of key performance...

*Result*: A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation.

Title:
A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation.
Authors:
Bracey A; Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA. Electronic address: braceya@amc.edu., Lacy AJ; Washington University School of Medicine in St Louis, Department of Emergency Medicine, St. Louis, MO, USA., Weingart SD; Nassau University Medical Center, Department of Emergency Medicine, East Meadow, NY, USA., Ata A; Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA; Albany Medical Center Hospital, Department of Surgery, Albany, NY, USA., Giuliano AS; University of Texas Southwestern, Department of Anesthesia, Dallas, TX, USA., Lewis JC; MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, ME, USA., Mantas J; Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA., Bayly B; Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA., Doyle M; Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA., Barnicle RN; Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI, USA.
Source:
The American journal of emergency medicine [Am J Emerg Med] 2026 Mar; Vol. 101, pp. 152-158. Date of Electronic Publication: 2026 Jan 02.
Publication Type:
Journal Article; Observational Study
Language:
English
Journal Info:
Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE
Imprint Name(s):
Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
MeSH Terms:
Laryngoscopy*/methods , Laryngoscopy*/standards , Intubation, Intratracheal*/methods , Intubation, Intratracheal*/instrumentation , Medical Errors*/classification , Medical Errors*/statistics & numerical data , Video-Assisted Techniques and Procedures*, Humans ; Video Recording ; Emergency Service, Hospital ; Clinical Competence ; Reproducibility of Results
Contributed Indexing:
Keywords: Airway; HAVL; Hyperangulated; Performance errors; Video laryngoscopy
Entry Date(s):
Date Created: 20260111 Date Completed: 20260208 Latest Revision: 20260209
Update Code:
20260210
DOI:
10.1016/j.ajem.2025.12.041
PMID:
41520635
Database:
MEDLINE

*Further Information*

*Background: Video laryngoscopy (VL) is now ubiquitous in emergency airway management. Hyperangulated video laryngoscopy (HAVL) differs from standard geometry VL (SGVL) in blade design, technique, and required microskills, yet the two are often regarded similarly. Despite widespread use, no comprehensive taxonomy of HAVL-specific performance errors exists.
Methods: We conducted an observational study of video-recorded endotracheal intubations (ETIs) performed in an urban academic emergency department (2020-2024). Fifty HAVL videos were first analyzed to derive 20 performance errors, followed by 100 additional recordings to confirm findings and assess incidence. Two independent emergency physicians evaluated each recording for performance errors. Interrater reliability and correlations among errors, procedure duration, and intubation success were assessed using Cohen's κ, Gwet's AC, and Pearson's correlation.
Results: We identified 20 discrete performance errors associated with HAVL. All 100 recordings contained at least one performance error (pooled κ = 0.53, 95 % CI 0.48-0.58). The most common error was failure to engage the midline vallecula (56 %), and the least common was bougie delivery issues (1 %). Each additional performance error added approximately 3 s to intubation duration. Strong correlations were observed among several errors.
Conclusions: Performance errors during HAVL are common and interrelated. This novel taxonomy provides a framework for structured feedback, targeted training, and future investigation of HAVL technique and clinical outcomes.
(Copyright © 2026 Elsevier Inc. All rights reserved.)*

*Declaration of competing interest AB – Medical Consultant - Verathon, Inc. AJL – None. SDW – None. AA – None. ASG – None. JCL – None. JM – None. BB – None. MD – None. RNB – None.*