Abstract
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 study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. Results In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16–21) for MAC, 18 s (IQR: 16–21) for McGrath, and 27 s (IQR: 23–34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (Conclusions The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.
Highlights
Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine
All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. e study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction
Our hypothesis was that the video laryngoscopes are superior in terms of intubation success rate compared to Macintosh laryngoscope (MAC) if used by paramedics in a manikin setting
Summary
Advanced airway management is crucial in the treatment of severely injured or sick patients [1]. Video laryngoscopy was introduced into clinical practice to ease endotracheal intubation and might be especially useful in less experienced providers like paramedics. E McGrath video laryngoscope (Aircraft Medical, Edinburgh, United Kingdom) is a portable video laryngoscope with Macintosh-style blades for paediatric and adult patients It is in clinical use for many years and is widely used in both in-hospital and out-of-hospital settings [7, 8]. Our hypothesis was that the video laryngoscopes are superior in terms of intubation success rate compared to MAC if used by paramedics in a manikin setting. Afterwards, paramedics were allowed to familiarize themselves with the McGrath and TruView PCD laryngoscopes and were asked to perform at least one successful intubation with each device. Paramedics were asked to perform 5 intubations in 5 subsequent airway scenarios. All statistical tests were two-sided. e one-way ANOVA on ranks was applied to compare the different times and to determine the statistical difference for each group (post hoc Bonferroni correction was used to counteract the problem of multiple comparisons)
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