open access

Vol 5, No 3 (2020)
Research paper
Published online: 2020-09-16
Get Citation

VieScope® laryngoscope versus Macintosh laryngoscope during difficult intubation performed by paramedics: a randomized cross-over manikin trial

Maciej Maslanka, Jacek Smereka, Lukasz Czyzewski, Jerzy Ladny, Marek Dabrowski, Lukasz Szarpak
DOI: 10.5603/DEMJ.a2020.0031
·
Disaster Emerg Med J 2020;5(3):134-141.

open access

Vol 5, No 3 (2020)
ORIGINAL ARTICLES
Published online: 2020-09-16

Abstract

INTRODUCTION: The aim of this study was to evaluate intubation performance by paramedics using Macintosh
laryngoscope and VieScope® laryngoscope under simulated difficult airway conditions.


METHODS: In a randomized, single-blinded, cross-over simulation trial, 42 paramedics performed endotracheal
intubation using VieScope® and Macintosh (MAC) laryngoscopes in two difficult airway scenarios: (A)
tongue edema, (B) manual cervical inline stabilization. The order of participants and intubation methods was
random. Time to ventilation constituted the primary outcome, and the secondary outcomes were the success
rate of first intubation attempt, overall intubation success rate, Cormack and Lehane grade, and ease of use.


RESULTS: In scenario A, the median overall intubation time was 55s (46–109) in the MAC group and 30.5s
(26–35) in the VieScope® group (p < 0.001). The efficacy of the first intubation attempt with MAC and Vie-
Scope® varied and amounted to 64.3% vs. 95.2% (p < 0.001). During scenario B, VieScope® offered better
intubation conditions than MAC (p < 0.001), including shorter intubation time, higher first attempt and
overall intubation success rates, as well as better glottic view.


CONCLUSIONS: In this simulation trial, we found that VieScope® could be successfully used for intubation in
difficult airways by paramedics with little simulation experience with this device. VieScope® was associated
with shorter time and higher success rates of intubation attempt compared with MAC. Nevertheless, we
recommend that the performance of VieScope® and MAC should be further evaluated in the clinical setting
to confirm our results.

Abstract

INTRODUCTION: The aim of this study was to evaluate intubation performance by paramedics using Macintosh
laryngoscope and VieScope® laryngoscope under simulated difficult airway conditions.


METHODS: In a randomized, single-blinded, cross-over simulation trial, 42 paramedics performed endotracheal
intubation using VieScope® and Macintosh (MAC) laryngoscopes in two difficult airway scenarios: (A)
tongue edema, (B) manual cervical inline stabilization. The order of participants and intubation methods was
random. Time to ventilation constituted the primary outcome, and the secondary outcomes were the success
rate of first intubation attempt, overall intubation success rate, Cormack and Lehane grade, and ease of use.


RESULTS: In scenario A, the median overall intubation time was 55s (46–109) in the MAC group and 30.5s
(26–35) in the VieScope® group (p < 0.001). The efficacy of the first intubation attempt with MAC and Vie-
Scope® varied and amounted to 64.3% vs. 95.2% (p < 0.001). During scenario B, VieScope® offered better
intubation conditions than MAC (p < 0.001), including shorter intubation time, higher first attempt and
overall intubation success rates, as well as better glottic view.


CONCLUSIONS: In this simulation trial, we found that VieScope® could be successfully used for intubation in
difficult airways by paramedics with little simulation experience with this device. VieScope® was associated
with shorter time and higher success rates of intubation attempt compared with MAC. Nevertheless, we
recommend that the performance of VieScope® and MAC should be further evaluated in the clinical setting
to confirm our results.

Get Citation

Keywords

endotracheal intubation, difficult airway, VieScope® laryngoscope, channeled laryngoscope, medical simulation, paramedic

About this article
Title

VieScope® laryngoscope versus Macintosh laryngoscope during difficult intubation performed by paramedics: a randomized cross-over manikin trial

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 5, No 3 (2020)

Article type

Research paper

Pages

134-141

Published online

2020-09-16

DOI

10.5603/DEMJ.a2020.0031

Bibliographic record

Disaster Emerg Med J 2020;5(3):134-141.

Keywords

endotracheal intubation
difficult airway
VieScope® laryngoscope
channeled laryngoscope
medical simulation
paramedic

Authors

Maciej Maslanka
Jacek Smereka
Lukasz Czyzewski
Jerzy Ladny
Marek Dabrowski
Lukasz Szarpak

References (29)
  1. Lockey DJ, Healey B, Crewdson K, et al. Advanced airway management is necessary in prehospital trauma patients. Br J Anaesth. 2015; 114(4): 657–662.
  2. Szarpak L. Laryngoscopes for difficult airway scenarios: a comparison of the available devices. Expert Rev Med Devices. 2018; 15(9): 631–643.
  3. Soar J, Nolan JP, Böttiger BW, et al. Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–147.
  4. Sakles JC, Mosier JM, Patanwala AE, et al. The Utility of the C-MAC as a Direct Laryngoscope for Intubation in the Emergency Department. J Emerg Med. 2016; 51(4): 349–357.
  5. Sakles JC, Mosier J, Chiu S, et al. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012; 60(6): 739–748.
  6. Mallick T, Verma A, Jaiswal S, et al. Comparison of the time to successful endotracheal intubation using the Macintosh laryngoscope or KingVision video laryngoscope in the emergency department: A prospective observational study. Turk J Emerg Med. 2020; 20(1): 22–27.
  7. Choi HJ, Je SMo, Kim JiH, et al. Korean Emergency Airway Registry Investigators. The factors associated with successful paediatric endotracheal intubation on the first attempt in emergency departments: a 13-emergency-department registry study. Resuscitation. 2012; 83(11): 1363–1368.
  8. Crewdson K, Lockey DJ, Røislien J, et al. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. Crit Care. 2017; 21(1): 31.
  9. Rognås L, Hansen TM, Kirkegaard H, et al. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013; 21: 58.
  10. Moher D, Hopewell S, Schulz K, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012; 10(1): 28–55.
  11. Glosser L. Assessment of endotracheal tube intubation. Review of existing scales. Disaster and Emergency Medicine Journal. 2017; 2(2): 91–93.
  12. Das B, Nasreen F, Haleem S, et al. A "cannot ventilate, cannot intubate" situation in a patient posted for emergency surgery for acute intestinal obstruction. Anesth Essays Res. 2013; 7(1): 140–141.
  13. Higgs A, McGrath BA, Goddard C, et al. Difficult Airway Society. DAS guidelines on the airway management of critically ill patients. Anaesthesia. 2018; 73(8): 1035–1036.
  14. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018; 319(21): 2179–2189.
  15. Szarpak L, Smereka J, Ladny JR. Comparison of Macintosh and Intubrite laryngoscopes for intubation performed by novice physicians in a difficult airway scenario. Am J Emerg Med. 2017; 35(5): 796–797.
  16. Szalast P, Smereka J, Ruetzler K, et al. Comparison of Airtraq® and Macintosh laryngoscope applied by nurses in manikins with normal and difficult airways: pilot data. Postępy Nauk Medycznych. 2018; 31(05).
  17. Al-Ghamdi AA, El Tahan MR, Khidr AM. Comparison of the Macintosh, GlideScope®, Airtraq®, and King Vision™ laryngoscopes in routine airway management. Minerva Anestesiol. 2016; 82(12): 1278–1287.
  18. Ruetzler K, Szarpak L, Smereka J, et al. Comparison of Direct and Video Laryngoscopes during Different Airway Scenarios Performed by Experienced Paramedics: A Randomized Cross-Over Manikin Study. Biomed Res Int. 2020; 2020: 5382739.
  19. Sinha R, Ray BR, Sharma A, et al. Comparison of the C-MAC video laryngoscope size 2 Macintosh blade with size 2 C-MAC D-Blade for laryngoscopy and endotracheal intubation in children with simulated cervical spine injury: A prospective randomized crossover study. J Anaesthesiol Clin Pharmacol. 2019; 35(4): 509–514.
  20. Hosalli V, Arjun BK, Ambi U, et al. Comparison of Airtraq™, McCoy™ and Macintosh laryngoscopes for endotracheal intubation in patients with cervical spine immobilisation: A randomised clinical trial. Indian J Anaesth. 2017; 61(4): 332–337.
  21. Çolak A, Çopuroğlu E, Yılmaz A, et al. A Comparison of the Effects of Different Types of Laryngoscope on the Cervical Motions: Randomized Clinical Trial. Balkan Med J. 2015; 32(2): 176–182.
  22. Hirabayashi Y, Fujita A, Seo N, et al. A comparison of cervical spine movement during laryngoscopy using the Airtraq or Macintosh laryngoscopes. Anaesthesia. 2008; 63(6): 635–640.
  23. Suppan L, Tramèr MR, Niquille M, et al. Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2016; 116(1): 27–36.
  24. Rendeki S, Keresztes D, Woth G, et al. Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices. BMC Anesthesiol. 2017; 17(1): 68.
  25. Saraçoğlu A, Dal D, Baygın Ö, et al. Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study. Turk J Anaesthesiol Reanim. 2016; 44(2): 76–80.
  26. Gómez-Ríos MÁ, Pinegger S, de Carrillo Mantilla M, et al. A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin. Braz J Anesthesiol. 2016; 66(3): 289–297.
  27. Majer J, Jaguszewski MJ, Frass M, et al. Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study. Cardiol J. 2019; 26(5): 529–535.
  28. Smereka J, Madziala M, Szarpak L. Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial. Cardiol J. 2019; 26(6): 761–768.
  29. Frass M, Smereka J, Ruetzler K, et al. New Flexible Tip Bougie catheter for difficult airway intubation. A randomized, crossover pilot study. Disaster and Emergency Medicine Journal. 2019; 4(2): 50–54.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl