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Laryngoscopes used in this study: (a) Macintosh laryngoscope; (b) McGrath MAC video laryngoscope; (c) TruView PCD video laryngoscope.
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Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine.
Aim:
The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios.
Methods:
This prospective cross-over simulation stu...
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Background: video laryngoscope (VL) is recommended for intubating difficult airways.
In case of difficult intubation, it has been estimated the chances of success are maximized if the operator is experienced in the use of VL. This is underlined in the Difficult Airway Society’s 2015 guidelines that recommend VL should be promptly available any time...
Background and aims:
Video laryngoscopy highly improves the success rate for endotracheal intubation. However, commercially available video laryngoscopes such as McGrath MAC® can be costly. An economical video laryngoscope was assembled by attaching a fibreoptic videoscope into a Macintosh laryngoscope. This randomised study aimed to compare the i...
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The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation–associated events and desaturation among these patients.
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Citations
... While experienced airway operators may be skillful in various intubating tools and techniques, it is understandable that the novices (medical students, residents, non-anesthesiology trainees) might encounter difficulties during the learning and practice. Therefore, various training modules and assessment of tracheal intubation (e.g., VL and DL) for medical personnel have been reported [167][168][169][170]. Training inexperienced novice personnel with a VL, e.g., following a short teaching program, improves the success rate and time for tracheal intubation in patients with normal airways [171] or in airway manikin with various simulated clinical scenarios [172]. ...
Laryngoscopy for tracheal intubation has been developed for many decades. Among various conventional laryngoscopes, videolaryngoscopes (VL) have been applied in different patient populations, including difficult airways. The safety and effectiveness of VL have been repeatedly studied in both normal and difficult airways. The superiority of VL then has been observed and is advocated as the standard of care. In contrast to laryngoscopy, the development of video-assisted intubating stylet (VS, also named as styletubation) has been noticed two dec-ades ago. Since then, sporadic clinical experiences of use have appeared in literature. In this re-view article, we presented our vast use experiences of the styletubation (more than 55,000 pa-tients since 2016). We found this technique is swift (the time to intubate: from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satis-faction and fast learning curve for the novice trainees) in both normal and difficult airway sce-narios. We therefore propose styletubation technique can be feasibly applied as universal rou-tine use for tracheal intubation.
... To stabilize the cervical spine in such patients, it is recommended to apply manual in-line stabilization throughout tracheal intubation [4]. Regardless of airway difficulty or cervical spine stabilization, videolaryngoscopy offers several advantages over direct laryngoscopy for both patients and manikins, such as a better laryngeal view, ease of tracheal intubation, and smaller cervical spine movement during intubation [5][6][7][8][9][10][11][12][13][14]. However, cervical spine movement, to a certain extent, is inevitable, even during videolaryngoscopic intubation under cervical spine stabilization, because a lifting force must be applied to visualize the glottis [15][16][17][18][19]. Therefore, finding additional methods to reduce cervical spine movement during videolaryngoscopic intubation under cervical spine stabilization has clinical significance. ...
Background
During videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods.
Methods
Videolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput–C1, C1–C2, and C2–C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time).
Results
Cervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput–C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1–C2 and C2–C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0–35.0] vs. 22.0 [18.0–27.0] s, P < 0.001).
Conclusions
When performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput–C1.
Trial registration
Clinical Research Information Service (number: KCT0006239, date: 10/06/2021).
... [5][6][7] The application of a VL, providing a magnified view of the infant's upper airway, reduces the number of intubation attempts and might also minimize airway trauma. [8][9][10][11][12][13][14][15][16][17] Furthermore, trainees and teachers considered VL a valuable and helpful teaching tool. [18][19][20] A study by Ozawa et al has also described the use of VL for better visualization when intubating within the incubator. ...
Backgrounds:
This study aimed to determine the best educational application of a respiratory function monitor and a video laryngoscope.
Methods:
This study was a randomized controlled simulation-based trial, including 167 medical students. Participants had to execute ventilation and intubation maneuvers on a newborn manikin. Participants were randomized into 3 groups. In group A (no-access), the feedback devices were not visible but recording. In group B (supervisor-access), the feedback devices were visible to the supervisor only. In group C (full-access), both the participant and the supervisor had visual access.
Results:
The two main outcome variables were the percentage of ventilations within the tidal volume target range (4-8mL/kg) and the number of intubation attempts. Group C achieved the highest percentage of ventilations within the tidal volume target range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P < .001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P < .001, A to C: P < .001, B to C: P = .003). Overall, group C achieved superior ventilation quality regarding primary and secondary outcome measures. The number of intubation attempts until success was lowest in the full-access group (full-access: 1.29, supervisor-access: 1.77, no-access: 2.43; A to B: P = .001, A to C: P < .001, B to C: P = .015).
Conclusions:
Our findings confirm that direct visual access to feedback devices for supervisor and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.
... Indirect (video) laryngoscopy is a new addition to airway management and there is increasing evidence of its usefulness in management of the difficult airway. [8][9][10][11][12] Video laryngoscopes offer indirect laryngoscopy, combining features of both flexible fibreoptic scopes and standard rigid laryngoscopes. They contain miniature video cameras enabling the operator to visualise the glottis indirectly, improving the view of the glottis, decreasing complication rates and improving the success rate compared to conventional laryngoscopes. ...
... It can be used both in patients with normal and difficult airways. [8,9,15,20] Recent evidence show that the McGrath MAC video laryngoscope has a high first-attempt intubation success, low soft tissue injury and a reduced overall incidence of difficult intubation. [11,15,20,21] A search in the literature revealed paucity of discourse on the use of both laryngoscopes in difficult airway patients. ...
... Most of the available literature comparing the McGrath MAC video laryngoscope to the McCoy laryngoscope either use easy airways or simulated difficult airways using manikins. [8][9][10]12,15,20] It has remained unclear which will be superior in the setting of a difficult airway when performed by a provider who is experienced with the use of both devices on real patients. ...
Background:
Difficult airway management remains one of the most challenging clinical situations encountered by anaesthetists.
Aim:
The study compared the effectiveness of the McGrath MAC video laryngoscope to the McCoy® laryngoscope in patients with difficult airway.
Materials and methods:
Following the institution's ethical approval, the randomised controlled trial was conducted involving 74 adults with American Society of anaesthesiologists' physical status (ASA) grading of I-III scheduled for elective surgery. The Patients were randomised into either group MVL (McGrath MAC) or group MCC (McCoy) and intubated after preoxygenation with 100% oxygen and administration of IV propofol and suxamethonium. The Intubation Difficulty Score (IDS), success rate of intubation, time to intubation, number of optimising manoeuvres and complications was assessed. Statistical analysis was performed using the statistical Package for Social Sciences (SPSS) version 24.0 computer software (IBM SPSS Statistics, IBM Corp. NY, United States). Numerical and categorical data were compared using the student's t-test and Chi square (χ2) test respectively. A value of P < 0.05 was considered statistically significant.
Results:
Lower IDS scores were noted in the McGrath group; 54.1% vs. 5.4% of patients had IDS score of 0 in the McGrath and McCoy groups respectively, (P < 0.001). Overall success rate was higher in the McGrath group (100% vs. 89.1%), P = 0.040.
Conclusion:
Lower IDS scores and improved intubation success rate was achieved with the McGrath compared with the McCoy laryngoscope in patients with predicted difficult airway. The McGrath has proved to be useful in managing patients with difficult airway.
... Fifty-four (65.1%) of the volunteers participating in the study were female, and 29 (34.9%) were male. Their mean age was 20±1.5 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) years. Moreover, 32 of the volunteers (38.6%) were first-year, and 51 (61.4%) were second-year students. ...
... In contrast, Vedel et al. reported that experienced personnel were more successful in terms of time, even in their first encounter with the video laryngoscope, compared with direct laryngoscopy (20). Also, Ruetzler et al. emphasized in their study that intubation is faster with video laryngoscope (21). There was no difference between the two methods in terms of convenience assessment by the volunteers. ...
Introduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization. Methods: In this cross-sectional study, the manikin’s neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.
... This study though being highly progressive in technological aspects includes limitations of not yet being well evaluated across a vast range of patients with different anatomical responses and adaptations, thus limiting its generalized usage. Up till now, the advancements are only specified to the aspect of visual analysis (Ruetzler et al., 2020), yet visualization alone is not enough to provide adequate acknowledgement of the inner condition of larynx (Kuo et al., 2020), As some diseases alter the temperature and humidity level of larynx, laryngopharyngeal reflux disease can change in pH of larynx and can cause damage to the mucosal lining including mouth cavity, larynx, pharynx or it can result in ear inflammation as well (Włodarczyk et al., 2019) therefore, further investigation of laryngeal pathologies during the visual analysis of the larynx and vicinity is required. ...
... Journals discussing the comparison of McGrath® Mac videolaryngoscope with direct laryngoscope (Macintosh) have been included after reviewed through the titles and abstracts and the remaining 11 journals. (12,13,22,(14)(15)(16)(17)(18)(19)(20)(21) Then, 2 studies using patients, (12,13) 3 studies using a pediatric manikin, (14-16) one studies used manikin but the required data were incomplete because trials were conducted on normal airways, (17) and the other one studies did not include success rate in the results. (18) Figure 1 shows the PRISMA diagram. ...
... Finally, 4 studies using adult manikin with a total of 247 participants were included in this systematic review. (19)(20)(21)(22) Endotracheal intubation trials that perform in manikin were carried out in 4 journals with 3 journals carried out by paramedics (which have more than 5 years of work experience, have experience using laryngoscopes, and no experience) including anesthesiologist (residents, consultants, and expert consultants), (19,20,22) as well as one other article conducted by medical students. (21) Three of four studies that will be reviewed compared 3 instruments in their articles and both of the instrument is McGrath® Mac videolaryngoscope and Macintosh laryngoscope. ...
... Finally, 4 studies using adult manikin with a total of 247 participants were included in this systematic review. (19)(20)(21)(22) Endotracheal intubation trials that perform in manikin were carried out in 4 journals with 3 journals carried out by paramedics (which have more than 5 years of work experience, have experience using laryngoscopes, and no experience) including anesthesiologist (residents, consultants, and expert consultants), (19,20,22) as well as one other article conducted by medical students. (21) Three of four studies that will be reviewed compared 3 instruments in their articles and both of the instrument is McGrath® Mac videolaryngoscope and Macintosh laryngoscope. ...
Introduction: McGrath® MAC videolaryngoscope is a single-handed device designed to facilitate intubation in patients both in patients with normal airway conditions (without any complications) or airway conditions with complications such as cervical spine and/or anatomic abnormalities. Objective: This study aims to compare McGrath® MAC videolaryngoscope and direct laryngoscope using Macintosh blades as learning material or study simulators for medical personnel (including anesthesiologist and paramedics) and novice operator (medical students). Method: this study is a systematic review using the PRISMA method which was carried out systematically. Data was collected through Pubmed, direct science, EBSCOHost, and Proquest using the keywords ‘airway management ', ‘laryngoscopy', and 'manikin'. Journal included based on published publication time between 2008 and 2020, a study using SimMan Laerdal Airway manikin, a journal discussing intubation using McGrath® MAC videolaryngoscope and direct laryngoscope with Macintosh blades here, where it is normal airway (without complications) and difficult airway. Results: 1556 journals were collected through 4 journal search sites and then carried out a screening process for the publication year approved in 2008 to 2020. Four studies use adult manikin SimMan Laerdal Airway including 247 participants were included in this systematic review. Conclusion: Based on journals that have been reviewed, McGrath® MAC videolaryngoscope provides better and superior results compared to Macintosh in terms of the success rate and visualization of glottis. Also, the intubation time using McGrath® MAC videolaryngoscope is shorten compared to Macintosh both on the normal airway (without complication) and difficult airway. The participants (medical personnel and novice operators) in all studies that reviewed prefer to use McGrath® Mac videolaryngoscope instead of using direct laryngoscope with Macintosh blade for Endotracheal Intubation mainly used for learning or study simulators.
... Endotracheal intubation under trauma conditions or suspicion of cervical spine injury in pre-hospital settings requires cervical spine stabilization with at least manual cervical inline stabilization. Numerous studies have shown that direct laryngoscopic intubation under such conditions is ineffective and prolonged in time compared with normal airway intubation [17][18][19]. In patients undergoing endotracheal intubation with cervical immobilization, Hosalli et al. [20] showed that channeled laryngoscopes were superior to Macintosh laryngoscopes, with greater ease of intubation and lower impact on hemodynamic variables. ...
INTRODUCTION: The aim of this study was to evaluate intubation performance by paramedics using Macintosh laryngoscope and VieScope® laryngoscope under simulated difficult airway conditions.
METHODS: In a randomized, single-blinded, cross-over simulation trial, 42 paramedics performed endotracheal intubation using VieScope® and Macintosh (MAC) laryngoscopes in two difficult airway scenarios: (A) tongue edema, (B) manual cervical inline stabilization. The order of participants and intubation methods was random. Time to ventilation constituted the primary outcome, and the secondary outcomes were the success rate of first intubation attempt, overall intubation success rate, Cormack and Lehane grade, and ease of use.
RESULTS: In scenario A, the median overall intubation time was 55s (46–109) in the MAC group and 30.5s (26–35) in the VieScope® group (p < 0.001). The efficacy of the first intubation attempt with MAC and Vie- Scope® varied and amounted to 64.3% vs. 95.2% (p < 0.001). During scenario B, VieScope® offered better intubation conditions than MAC (p < 0.001), including shorter intubation time, higher first attempt and overall intubation success rates, as well as better glottic view.
CONCLUSIONS: In this simulation trial, we found that VieScope® could be successfully used for intubation in difficult airways by paramedics with little simulation experience with this device. VieScope® was associated with shorter time and higher success rates of intubation attempt compared with MAC. Nevertheless, we recommend that the performance of VieScope® and MAC should be further evaluated in the clinical setting to confirm our results.
... Videolaryngoscopy is considered an acceptable alternate technique compared to direct laryngoscopy, but clinical evidence is mostly based on clinical studies performed in adult patients. [10][11][12] Results of studies performed in adults cannot extrapolate into the pediatric population, as pediatric patients are much more challenging due to their more challenging airway anatomy and physiology. [13,14] Videolaryngoscopy in pediatric patients is generally believed to provide favorable airway visualization, but Editor: Abdelouahab Bellou. ...
... [15,16] Airway management in the pediatric out-of-hospital emergency setting is challenging, especially if performed by relatively unexperienced airway providers like paramedics. [4,10,17] Airway assistance tools like bougies have been reported to be beneficial, especially if used by paramedics. [18] Once the bougie is placed between the vocal cord, an endotracheal tube can be inserted via the bougie into the trachea. ...
Context:
Endotracheal intubation of pediatric patients is challenging, especially in the pre-hospital emergency setting and if performed by less experienced providers. Securing an airway should be achieved with a single intubation attempt, as each intubation attempt contributes to morbidity and mortality. A new airway device, the VieScope, was recently introduced into clinical market, but efficacy to reduced intubation attempts remains unclear thus far.
Objective:
We aimed to compare endotracheal intubation by paramedics using the Vie Scope in different pediatric airway simulation conditions.
Methods:
We conducted a randomized, cross-over simulation study. Following a theoretical and practical training session, paramedics performed endotracheal intubation in 3 different pediatric emergency scenarios: normal airway; tongue edema; cardiopulmonary resuscitation using the VieScope. Overall intubation success rate was the primary outcome. Secondary outcomes included number of intubation attempts, time to intubation, Cormack-Lehane grade, POGO score, and ease of use (using 1-100 scale).
Results:
Fifty-five paramedics with at least 2 years of clinical experience and without any previous experience with the VieScope participated in this study. The overall intubation success rate was 100% in all 3 scenarios. The median intubation time was 27 (24-34) versus 27 (25-37) versus 29 (25-40) s for scenarios A, B, and C, respectively. In scenario A, all paramedics performed successful intubation with 1 single intubation attempt, whereas 2% of the paramedics had to perform 2 intubation attempts in scenario B and 9% in scenario C.
Conclusions:
Results of this simulation study indicate preliminary evidence, that the VieScope enables adequate endotracheal intubation in the pediatric setting. Further clinical studies are needed to confirm these results.
Laryngoscopy for tracheal intubation has been developed for many decades. Among various conventional laryngoscopes, videolaryngoscopes (VLs) have been applied in different patient populations, including difficult airways. The safety and effectiveness of VLs have been repeatedly studied in both normal and difficult airways. The superiority of VLs then has been observed and is advocated as the standard of care. In contrast to laryngoscopy, the development of video-assisted intubating stylet (VS, also named as styletubation) was noticed two decades ago. Since then, sporadic clinical experiences of use have appeared in the literature. In this review article, we presented our vast use experiences of the styletubation (more than 55,000 patients since 2016). We found this technique to be swift (the time to intubate from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction and fast learning curve for the novice trainees) in both normal and difficult airway scenarios. We, therefore, propose that the styletubation technique can be feasibly applied as universal routine use for tracheal intubation.
