Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios: A randomised controlled manikin study

TY - JOUR

T1 - Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios

T2 - A randomised controlled manikin study

AU - Jepsen, Cecilie H

AU - Gätke, Mona R

AU - Thøgersen, Bente

AU - Mollerup, Lene T

AU - Ruhnau, Birgitte

AU - Rewers, Mikael

AU - Rosenstock, Charlotte V

PY - 2014/3

Y1 - 2014/3

N2 - BACKGROUND Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesising that the McGrath videolaryngoscope intubation would prove faster than FFE intubation. DESIGN A randomised controlled study. SETTING The Danish Institute for medical simulation between December 2009 and June 2010. PARTICIPANTS Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course. INTERVENTIONS All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES We measured successful intubations, defined as intubation within 120 s, and time to tracheal intubation. RESULTS The trachea was intubated within 120 s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P<0.0001). CONCLUSION The McGrath videolaryngoscope is a valuable device with higher success rate and a quicker performance in simulated difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.

AB - BACKGROUND Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesising that the McGrath videolaryngoscope intubation would prove faster than FFE intubation. DESIGN A randomised controlled study. SETTING The Danish Institute for medical simulation between December 2009 and June 2010. PARTICIPANTS Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course. INTERVENTIONS All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES We measured successful intubations, defined as intubation within 120 s, and time to tracheal intubation. RESULTS The trachea was intubated within 120 s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P<0.0001). CONCLUSION The McGrath videolaryngoscope is a valuable device with higher success rate and a quicker performance in simulated difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.

KW - Airway Management

KW - Airway Obstruction

KW - Algorithms

KW - Anesthesiology

KW - Clinical Competence

KW - Denmark

KW - Equipment Design

KW - Fiber Optic Technology

KW - Humans

KW - Internship and Residency

KW - Intubation, Intratracheal

KW - Laryngoscopes

KW - Laryngoscopy

KW - Manikins

KW - Pharynx

KW - Time Factors

KW - Video Recording

U2 - 10.1097/EJA.0b013e32836590a7

DO - 10.1097/EJA.0b013e32836590a7

M3 - Journal article

C2 - 24145800

SN - 0265-0215

VL - 31

SP - 131

EP - 136

JO - European Journal of Anaesthesiology

JF - European Journal of Anaesthesiology

IS - 3

ER -