Abstract
BackgroundDirect laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators. However, an increasing number of reports currently support videolaryngoscopy, particularly for novice users. The widespread use of videolaryngoscopy may be limited due to financial limitations, especially in low-income countries. Therefore, affordable single-use scopes are now becoming increasingly popular. We sought to compare these new scopes with direct laryngoscopes and the previously tested videolaryngoscopes in mannequins by novices.MethodsFifty medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the Airtraq®, a custom-made videolaryngoscope, the King Vision®, the Macintosh laryngoscope and the VividTrac®, on an airway trainer (Laerdal Airway Management Trainer®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction.ResultsWe observed no differences in esophageal intubation. However, intubation-related times, the view of the glottis and operator satisfaction were significantly better throughout the study with the commercial videolaryngoscopes. In comparison, the custom-made videolaryngoscope performance proved to be similar to that of the Macintosh laryngoscope. The VividTrac® performance was similar (P > 0.05) or significantly better than that of the King Vision® in both scenarios.ConclusionsBased upon our results, the Airtraq®, King Vision® and VividTrac® were superior to the Macintosh laryngscope in both normal and difficult airway scencarios for novice users. In particular, our study is the first to report that the VividTrac® shows promise for further clinical evaluation.
Highlights
Direct laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators
Continuous and ordinal data are presented as the median and interquartile range (IQR), and the categorical data are presented as raw numbers and as frequencies
The overall longest intubation time (IT) was associated with the improvised VL (ID), and commercial VLs were faster than direct laryngoscopy (DL)
Summary
Direct laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators. The widespread use of videolaryngoscopy may be limited due to financial limitations, especially in low-income countries. We sought to compare these new scopes with direct laryngoscopes and the previously tested videolaryngoscopes in mannequins by novices. Videolaryngoscopy (VL) might be beneficial compared to DL for novices, the role of VL in airway management remains controversial [3, 4]. Patients may benefit from the availability of VL, especially in difficult airway situations, the clinical availability of VL remains limited, especially in low- and middle-income countries [5,6,7]. Low-cost custom-made devices are available and have already been partially tested [6, 8]
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