Is McGrath® MAC better than Glidescope® Ranger for novice providers in the simulated difficult airway? A randomized manikin study

Abstract

Purpose of this study:McGrath® MAC and Glidescope® Ranger are portable video laryngoscopes that are easy to learn for novice and useful in difficult airway environment. We anticipated that McGrath® MAC would show performance in intubation of novices as equal as Glidescope® Ranger in normal and difficult airway. Materials and Methods: Primary outcomes were the rate of successful intubation, intubation time and overall glottic view of McGrath® MAC,Glidescope® Ranger andMacintosh.Weperformed a prospective, single-blinded, randomized crossover study of 39 medical students using three laryngoscopes in amanikin,with simulated normal and difficult airway scenarios. Results: The successful intubation rate of McGrath® MAC (82.5 (38.5)%) was better than Macintosh (57.5 (50.1)%; p=0.026) and equal to Glidescope® Ranger (85 (36.2)%) at first attempt of easy scenario. However, McGrath® MAC was equal to Macintosh and Glidescope® Ranger from second to fifth attempt. The intubation timeofMcGrath® MAC (24.4 (14.7) s)was also equal toGlidescope® Ranger (22.2 (8.7) s) and Macintosh laryngoscopes (25.4 (12.2) s). The glottic view ofMcGrath® MAC (1 (1–1))was superior toMacintosh (2 (1–2); P=0.000) and equal to Glidescope® Ranger (1 (1-1)). Novicesachievedanequal successful intubation ratewhenusing the McGrath® MAC (94.9 (22.1)%) comparing with Glidescope® Ranger (93.3 (25)%) and Macintosh (92.3 (26.7)%) in difficult scenario (p=0.725). Intubation times were also similar for three laryngoscopes and became shorter with practice (p=0.000). The view at laryngoscopy with the McGrath® MAC was better than Macintosh (p=0.000) and not superior to Glidescope® Ranger (p=0.001). Conclusions: The rate for successful intubation and intubation time with McGrath® MAC in novices were equal to Glidescope® Ranger and Macintosh laryngoscope. Novices achieved a better glottic view with McGrath® MAC than Macintosh and not in comparison to Glidescope® Ranger in both of airway environments.