Successful Intubation Research Articles

Universal C-MAC® videolaryngoscope use in adult patients: a single-centre experience.

Universal use of Storz C-MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first-pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First-pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non-theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. > 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no-PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non-theatre 7/136, p < 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non-RSI 1/720 (0.1%), p = 0.008).

Is there an optimal place for holding the tracheal tube during intubation? A proof-of-concept randomised clinical trial

BackgroundThe optimal way to hold an endotracheal tube (ETT) during intubation has not been studied. In this randomised clinical trial, we examined the effect of site—holding the ETT in two...

Relationship Between Airway Examination with LEMON Criteria and Difficulty of Tracheal Intubation with IDS Criteria.

Tracheal intubation is a common technique used to secure a patient's airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient's airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway's appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems. This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared. In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152). The LEMON score is associated with difficult intubation in adult patients requiring intubation.

Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success

Airway management is a crucial part of out-of-hospital care. It is not known if the rate of overall agency intubation attempts is associated with intubation success. We sought to evaluate the association between agency intubation attempt rate and intubation success using a national out-of-hospital database. We conducted a retrospective secondary analysis of the ESO Data Collaborative from 2018 to 2019, and included all adult cases with an endotracheal intubation attempt. We calculated the number of intubations attempted per 100 responses, advanced life support responses, and transports for each agency. We excluded cases originating at health care facilities and outliers. We used multivariable logistic regression to evaluate the association between agency intubation attempt rate and 1) intubation success and 2) first-pass success. We adjusted for confounders. We included 1,005 agencies attempting 58,509 intubations. Overall, the intubation success rate was 78.8%, and the first-pass success rate was 68.5%. Per agency, the median rate of intubation attempts per 100 emergency medical service responses was 0.8 (interquartile range 0.6 to 1.1). Rates of intubation attempts per 100 responses (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.6 to 1.8), advanced life support responses (aOR 1.18; 95% CI 1.16 to 1.20), and transports (aOR 1.21; 95% CI 1.18 to 1.22) were all associated with intubation success. These relationships were similar for first-pass success but with smaller effect sizes. Higher agency rates of intubation attempts were associated with increased rates of intubation success and first-pass success.

Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

BackgroundThe utilization of video laryngoscopy (VL) has demonstrated superiority over direct laryngoscopy (DL) for intubation in surgical settings. However, its effectiveness in the intensive care unit and emergency department settings remains uncertain.MethodsWe systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing VL versus DL in critically ill patients. Critical setting was defined as emergency department and intensive care unit. This systematic review and meta-analysis followed Cochrane and PRISMA recommendations. R version 4.3.1 was used for statistical analysis and heterogeneity was examined with I2 statistics. All outcomes were submitted to random-effect models.ResultsOur meta-analysis of 14 RCTs, compromising 3981 patients assigned to VL (n = 2002) or DL (n = 1979). Compared with DL, VL significantly increased successful intubations on the first attempt (RR 1.12; 95% CI 1.04–1.20; p < 0.01; I2 = 82%). Regarding adverse events, VL reduced the number of esophageal intubations (RR 0.44; 95% CI 0.24–0.80; p < 0.01; I2 = 0%) and incidence of aspiration episodes (RR 0.63; 95% CI 0.41–0.96; p = 0.03; I2 = 0%) compared to DL.ConclusionVL is a more effective and safer strategy compared with DL for increasing successful intubations on the first attempt and reducing esophageal intubations in critically ill patients. Our findings support the routine use of VL in critically ill patients.Registration CRD42023439685 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439685. Registered 6 July 2023.

Comparison of TAScope (an Indigenous Videolaryngoscope) with McGrath MAC®: A Manikin Study

Background: Videolaryngoscopes are an important advancement in airway management. They are now commercially available in various designs and sizes, but are expensive. The Anaesthetist Society scope videolaryngoscope (TAScope) is an indigenously designed videolaryngoscope by a member of the anaesthesia fraternity and is economical. Before being adopted for clinical use, it is appropriate to study it rigorously. The objective of the present study was to compare the TAScope with the McGrath MAC® videolaryngoscope for time to successful intubation in an adult manikin. Methods: The present study was conducted on an adult intubation training manikin. The sequence of the use of either videolaryngoscope was chosen randomly by a computer-generated random sequence. The following parameters were noted: time of successful intubation, time required to obtain glottic view, glottic view obtained in terms of Cormack–Lehane grade and percentage of glottic opening score and number of attempts at intubation. Statistical analysis was done using SPSS version 23. Results: All intubations were successful with both videolaryngoscopes. The time for successful intubation was significantly faster with McGrath MAC® (18.31 ± 1.53 s) compared to TAScope (27.21 ± 3.03 s) (P &lt; 0.001). The time to obtain a glottic view was slightly shorter with TAScope (6.25 ± 1.78 s) compared to McGrath MAC® (6.66 ± 1.15 s). Conclusion: The time for intubation was longer with TAScope but with a similar glottic view and intubation success compared to McGrath videolaryngoscope.

Comparative Evaluation of Ease of Nasotracheal Intubation Using C-MAC versus TuoRen Video Laryngoscope in Adult Surgical Patients: A Randomized Study

Background and Aims: Laryngeal visualization and ease of intubation vary with the use of different video laryngoscopes. We compared the number of attempts taken for successful first-attempt nasotracheal intubation using C-MAC video laryngoscope versus TuoRen video laryngoscope. Ease of intubation and time taken, glottic view, and hemodynamic responses were also compared. Materials and Methods: It was a randomized, single-blinded trial conducted in eighty adult surgical patients with normal airways requiring nasotracheal intubation. In all patients, the protocols for induction and intubation were similar. In Group C, C-MAC video laryngoscope and in Group T, TuoRen video laryngoscope were used. Statistical analysis was done using independent samples t-test and Chi-squared test as applicable. Results: Successful first-attempt intubation was significantly higher in Group C compared to Group T (87.5% vs. 60%). Incidence of fogging was significantly lower in Group C compared to Group T (10% vs. 30%). Time taken for intubation was significantly higher in Group T (34.64 ± 4.38 s vs. 86.25 ± 8.56 s). The view of the glottis obtained was similar in both groups. A significantly higher number of patients in Group C had easy intubation (87.5% vs. 60%). Mean heart rate and mean arterial pressure were significantly higher in Group T after intubation. Conclusion: Successful first-attempt nasotracheal intubation was significantly higher with the use of C-MAC which required lesser attempts and time compared to TuoRen video laryngoscope. The glottic views obtained with both devices were comparable, but the ease of intubation was better and fogging was lesser with C-MAC. The use of TuoRen videoscope was associated with significantly higher hemodynamic responses.

Comparative Evaluation of Direct Laryngoscopy Versus GlideScope for the Purpose of Laryngoscopy Management and Intubation in Candidates of Cesarean Delivery with General Anesthesia.

The present study aimed at comparing the hemodynamic responses to laryngoscopy and initiation of intubation with either direct or video-assisted laryngoscopy. This double-blind clinical trial was performed on 90 pregnant women candidates for cesarean section under general anesthesia. The participants were divided into two groups. In the first group, intubation was performed using direct Macintosh laryngoscope (MCL group). The second group underwent intubation using the GlideScope video laryngoscope (GSL group). Then, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), the percentage of the saturation of peripheral oxygen (SpO2), the time-to-intubation (TTI), and the number of intubation attempts were recorded. SBP, DBP, and MAP in the MCL group were significantly higher than GSL group 1, 3, and 5 min after laryngoscopy (P < 0.05). HR in the MCL group with the mean of 118.44 ± 15.53 bpm was significantly higher than that the GSL group with the mean of 110.11 ± 16.68 bpm only 3 min after laryngoscopy (P = 0.016). The TTI in the MCL group was significantly longer than that of the GSL group (12.80 ± 1.86 vs. 10.15 ± 2.61; P = 0.001). The frequency of the first intubation attempt in the GSL group with 91.1% was significantly higher than that the MCL group with 84.4% (P = 0.003). It seems that the GSL technique is a better choice to conduct laryngoscopy with more success in intubation and a higher stability of the patients' hemodynamic status.

Comparison of outcomes between video laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in adults with cervical neck immobilization: A systematic review and meta-analysis of randomized controlled trials.

Comparing the outcomes of video-laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in patients with cervical spine immobilization. All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 8 Jan 2024 were included. All outcomes were analyzed using Review Manager 5.4. The primary outcomes were the successful first-attempt intubation rate, intubation time, heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage and sore throat. The meta-analysis included six randomized controlled studies with a total of 694 patients. The outcomes of the meta-analysis revealed that the use of video laryngoscopy was better than flexible fiberoptic bronchoscopy in terms of the successful first-attempt intubation rate (P<0.05) and intubation time (P<0.05) in patients with cervical spine immobilization. However, there were no statistically significant differences in heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage, or sore throat (all P>0.05) between the video laryngoscopy and flexible fiberoptic bronchoscopy groups. Compared with flexible fiberoptic bronchoscopy, video laryngoscopy has superior tracheal intubation performance in terms of the first-attempt success rate and intubation speed. This finding was observed in patients with cervical spine immobilization who utilized a cervical collar to simulate a difficult airway. Additionally, both types of scopes demonstrated similar complication rates. Current evidence suggests that video laryngoscopy is better suited than flexible fiberoptic bronchoscopy for endotracheal intubation in patients immobilized with a cervical collar. Systematic review protocol: CRD42024499868.

Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study

Objectivesprimary objective: to improve the FPS rates after an educational intervention. Secondary objective: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts. Designit was a prospective quasi-experimental study. Settingdone in an ED in a public Hospital in Argentina. Patientsthere were patients of all ages with intubation in ED. Interventionsin the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented. Main variables of interestthe operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL). Resultsdata from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89–77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20–90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training. Conclusionsa low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries.

Comparison of Rocuronium and Succinylcholine for First‐Attempt Intubation Success in the Emergency Department

Comparison of Rocuronium and Succinylcholine for First‐Attempt Intubation Success in the Emergency Department

Videostylet-guided Intubation in a Case of Huge Ranula: A Novel Technique for Paediatric Difficult Intubation

A large sublingual ranula compromises the anterior pharyngeal space and thus, there is a technical difficulty in direct laryngoscopy and endotracheal intubation. Videostylet-guided intubation has the advantage to overcome this difficulty. Here, we report successful videostylet-guided intubation in a case of huge plunging intraoral ranula in a 5-year-old female child posted for surgical excision of the ranula.

Progressing Airway Obstruction with A Simple Vallecular Cyst-Definitive Airway Challenge

Vallecular cysts, though uncommon, can lead to severe complications in an anesthetised patient if airway management is mishandled. We present a case of challenging intubation in a 65-year-old man with a vallecular cyst and outline the techniques and strategies employed to achieve successful awake intubation using a fiberoptic bronchoscope.

Comparison of McCoy, Macintosh, and Truview laryngoscope for bougie-aided naso-tracheal intubation: A randomized controlled study.

Video laryngoscopes are commonly used along with Macintosh and McCoy laryngoscopes for Nasotracheal intubation (NTI). The purpose of this study was to evaluate the performance of McCoy, Macintosh, and Truview laryngoscopes during bougie-aided NTI with respect to intubation time, success rate, and hemodynamic changes during the procedure. Forty-five American Society of Anesthesiologists (ASA) I-II adult patients, with Mallampati grade 1-4, requiring NTI, were enrolled after taking written informed consent. ASA III/IV, restricted mouth opening, and body mass index >30 were excluded from the study. Patients were randomly allocated to intubate with one of the three laryngoscopes (McCoy, Macintosh, and Truview) and the anesthesiologists were well experienced with all of them. The primary outcome was intubation time and secondary outcomes included first attempt success rate, external laryngeal manipulation, Cormack-Lehane (CL) grade, and hemodynamic responses. The intubation time of McCoy, Macintosh, and Truview, was 86.87 ± 15.92, 82.87 ± 16.46, and 79.93 ± 14.53 (mean ± standard deviation) seconds, respectively, which is comparable with Truview being the shortest. CL grade 1 was obtained more in the Truview group (53.3%) compared to the other two groups, while CL grade 3 was obtained in 20% each in McCoy and Macintosh groups. McCoy, Macintosh, and Truview laryngoscopes were comparable in performance during bougie-aided NTI, with Truview having the shortest intubation time and better visualization.

A Comparison of the Success of Intubation Using C-MAC D-Blade and McGrath MAC X3 Blade Videolaryngoscopes during Double Lumen Tube Insertion in One-Lung Ventilation: A Prospective, Randomized Clinical Trial

Objective: To compare the effects of C-MAC D-Blade and McGrath MAC X3 Blade videolaryngoscopes (VLs) during double lumen tube (DLT) insertion in one-lung ventilation (OLV) in patients who underwent chest surgery in terms of intubation durations, hemodynamic responses, and intubation-induced complications. Materials and methods: Fifty patients aged 18−65 years who were scheduled for OLV were included in this study. The patients were divided randomly into two groups: a Storz C-MAC D-Blade VL group (C-MAC group, n = 25) and a McGrath MAC X3 Blade VL group (McGrath group, n = 25). The results of a preoperative airway assessment, number of intubation attempts and incidence of success at the first attempt, glottic view times, intubation times, Cormack−Lehane scores, percentage of glottic opening (POGO) scores, ease of intubation, comorbidities, hemodynamic responses, and adverse intubation-related events were recorded. Results: The demographic characteristics and comorbidities of both groups were similar. The intubation characteristics of both groups were similar in terms of Cormack−Lehane scores, thyromental and intergingival distances, and POGO scores. In the C-MAC group, the glottic view times (p = 0.001) and intubation times (p = 0.001) were significantly shorter than those in the McGrath group. As shown by ease of intubation scores, ease of intubation in the C-MAC group was significantly better than that in the McGrath group (p = 0.001). All the patients in the C-MAC group were intubated at the first attempt, without a statistically significant difference. The two groups were similar with respect to intubation-related complications and hemodynamic responses (mean arterial pressure [MAP] and heart rate [HR]). Conclusion: We conclude that the C-MAC D-Blade VL is more beneficial for airway management due to shorter glottic view and intubation times, high success rates at the first attempt, and ease of intubation in patients intubated with a DLT in OLV.

Incidence and Predictors of Difficult Intubation in Patients Undergoing Thyroid Surgery

Introduction: Thyroid enlargement is considered a risk factor for challenging direct laryngoscopy and intubation. Airway management in patients with thyroid swelling presents unique challenges, requiring thorough preparation for potential difficult airways. Although airway management in the overall population has been thoroughly researched, there is a scarcity of literature specifically addressing airway management in individuals who have thyroid enlargement. Aim: To evaluate the incidence of difficult intubation in patients undergoing thyroid surgery, utilising the Intubation Difficulty Score (IDS). Materials and Methods: This cross-sectional observational study was conducted among 258 patients in the Department of Anaesthesiology, Government TD Medical College, Alappuzha, Kerala, India. Various parameters including Modified Mallampati score, neck circumference, Body Mass Index (BMI), inter-incisor distance, retrognathia, neck extension, thyromental distance, tracheal deviation, and tracheal compression were assessed for all patients with thyroid swelling. The incidence of difficult endotracheal intubation was analysed using the IDS and the time taken for successful intubation was recorded. Data were presented as mean±standard deviation (SD), frequencies, and percentages. The association between variables was analysed using the Chi-square test. Results: Thyroid disorders were more common in females 220 (85.3%) than in males 38 (14.7%). The variables such as BMI, Mallampati score, thyromental distance, inter-incisor distance, and neck mobility were not found to be associated with difficult intubation. However, increased neck circumference (&gt;43 cm) was statistically significant (p-value=0.007) in relation to difficult intubation. According to IDS, 94.2% of patients had easy intubation, while 5.8% experienced difficult intubation. In terms of intubation times, 72.5% of patients were intubated within 10-15 seconds, 24.4% within 16-20 seconds, and 3.1% took longer than 20 seconds. Conclusion: Thyroid surgery itself is not an independent predictive factor for difficult intubation. Among the predictive factors in the study population, a neck circumference greater than 43 cm was found to be associated with difficult endotracheal intubation during thyroid surgery

Ease of endotracheal intubation with the conventional polyvinyl chloride endotracheal tube versus wire-reinforced flexometallic tube through the intubating laryngeal mask airway: A comparative study.

The aim of our study was to compare the ease of intubation when using conventional PVC tubes versus the wire-reinforced flexometallic tubes with the ILMA-FastrachTM. The number of attempts, time taken and additional maneuvers were noted. Intra-operative hemodynamic changes, post-operative sore throat, bleeding and hoarseness of voice was recorded over a period of 24 hours. After informed consent, 60 ASA I-II patients undergoing elective surgeries under general anesthesia were allocated to undergo blind intubation with the PVC tube or the wire-reinforced flexometallic tube. More attempts were required for successful intubation using the wire-reinforced tube than the PVC tube with 76.7% passing in the first attempt in the PVC, and 53.3% passing in the first attempt in the flexometallic group. (P = 0.4). Average time for intubation in the PVC group: 28.24 ± 7.22 seconds. Average time for intubation in the flexometallic tube: 45.8 ± 15.78 sec. Occurrence of post-operative sore throat was 13.3% in the PVC group and 26.6% in the flexometallic group, with minimal hoarseness of voice 3.3% in the PVC group and 10% in the flexometallic group. There was also a slightly higher hemodynamic response in those who were intubated with the flexometallic tube than a PVC tube. Intubating via the ILMA-Fastrach with the PVC tube offered better intubating conditions with regards to lesser time taken, lesser attempts, less manipulation, and less hemodynamic variations as compared to the patients who were intubated using the wire-reinforced tube.

A randomised controlled trial to compare blind intubation success through LMA Blockbuster® and I-Gel® LMA.

Laryngeal mask airway-blockbuster (LMA-BT) is a relatively new supraglottic airway device (SGAD). In this study, we compared LMA-BT with I-Gel LMA for efficacy of blind tracheal intubation. We conducted a single-blind prospective study after ethical approval. One hundred American Society of Anesthesiology (ASA) Grade I-III (age 18-60 years) patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were included and randomly divided into 2 groups. Blind tracheal intubation was performed through LMA-BT ( n = 50) and I-Gel ( n = 50) in groups 1 and 2, respectively. The primary aim was to evaluate the first pass success rate of blind tracheal intubation through the LMAs. The secondary objectives noted were attempts and ease of LMA insertion, total time taken for LMA insertion, airway seal pressure of LMA, ease of NGT insertion through LMA, fibre-optic grading of laryngeal view through LMA, overall success rate and time of intubation through LMA, time for LMA removal, and complications, if any. In the LMA-BT group, the first pass success rate ( P < 0.019) and the overall success rate of intubation ( P < 0.005) were significantly higher than in the I-Gel group. Using LMA-BT also resulted in statistically significant shorter intubation time ( P < 0.0001) with higher airway seal pressure as compared to I-Gel ( P < 0.001). The difference in the first attempt insertion, number of insertion attempts, ease and time of LMA insertion and removal after intubation, and postoperative complications were comparable among the groups. LMA-BT is a superior device as compared to I-Gel LMA as a conduit for blind tracheal intubation.

Comparative study of the McGrath™ videolaryngoscope blades and conventional laryngoscopy efficacy during mechanical chest compressions: Insights from a randomized trial with 90 anesthesiologists on objective and subjective parameters.

This study aimed to compare the efficacy and utility of the McGrath™ videolaryngoscope, using the Macintosh-like McGrath™ MAC blade and the hyperangulated McGrath™ MAC Xblade with a conventional Macintosh blade under simulated resuscitation conditions. A prospective, randomized study under conditions mimicking ongoing chest compressions was conducted with 90 anesthesiologists. Intubation success rates, time-to-vocal cords, time-to-intubate, and time-to-ventilate were measured. Additionally, the study assessed the subjective ratings and the perceived workload using the 'NASA-task-load-index' during the procedure. The overall intubation success rate was device dependent 99-100%. The McGrath™ MAC and McGrath™ MAC Xblade showed faster visualization times compared to conventional blades. The MAC blade demonstrated superior performance in time-to-intubate and time-to-ventilate compared to both conventional and MAC Xblades. Despite excellent visualization, the MAC Xblade posed challenges in tube placement, reflected in a prolonged intubation time of >120 seconds in one case. Both MAC and MAC Xblade reduced potential dental injuries and interruptions to chest compressions compared to conventional laryngoscopes. User experience significantly impacted intubation times with conventional laryngoscopes, but this effect was mitigated with videolaryngoscopy. Participants reported lower stress and effort when using videolaryngoscopes, with the MAC blade rated superior in perceived time pressure. The study supports the superiority of videolaryngoscopy with a Macintosh-like blade over conventional laryngoscopy during mechanical chest compressions, particularly for less experienced users. The McGrath™ MAC blade, in particular, offers advantages in intubation time, user-friendliness, and reduced stress. However, the MAC Xblade's challenges during tube placement highlight the need for further clinical validation. Continued research is essential to refine guidelines and improve resuscitation outcomes.

The Efficacy of Utilizing Bougie Vs Stylet in Patients Requiring Endotracheal Intubation: Updated Systematic Review and Meta-Analysis

Introduction: Endotracheal intubation is a high-risk procedure that can be lifesaving for critically ill or injured patients. Assisted devices, such as the bougie and stylet, are commonly used to improve success rates and reduce complications. The bougie facilitates the passage of the endotracheal tube through the vocal cords while the stylet is inserted into the endotracheal tube prior to intubation. However, there is variation in clinical practice regarding the preference for using these devices in difficult airway management. Methods: This systematic review and meta-analysis included randomized controlled trials (RCTs) that compared the efficacy of bougie versus stylet in tracheal intubation. Medline, Embase, Cochrane Central of Controlled Trials and Clinical trials.gov were searched for studies discussing the same topic. The primary outcome was the first-attempt intubation success rate between the bougie and stylet. Our secondary outcomes were to compare the duration of intubation and the complications rates between bougie and stylet. Results: A total of 7 RCTs that enrolled participants(number?) were eligible. The bougie approach had a slightly higher success rate on the first attempt, but there was no significant difference between the methods (RR, 1.01; 95% CI, 0.90 to 1.15). The duration of intubation, pooled analysis indicated a statistically significant reduction in the duration of intubation with the stylet approach compared to the bougie approach (MD, 8.39; 95% CI, 2.87 to 13.91). Subgroup analysis revealed lower rates of esophageal intubation (RR, 0.65; 95% CI, 0.26 to 1.61, I2= 0%) and pneumothorax (RR, 0.94; 95% CI, 0.54 to 1.66, I2= 0%) in the bougie group. Conclusion: This study reported that no significant difference between the use of bougie vs stylet in terms of first attempt intubation success rates and the complication rates of endotracheal intubation. However, stylet displayed significantly shorter duration of intubation in comparison to bougie.