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Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study
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Abstract
INTRODUCTION: Airway management in pediatric trauma patients is challenging. Direct laryngoscopy is the gold standard for endotracheal intubation in emergency and trauma patients. The aim of the present study was to evaluate the performance of Miller (MIL) and Macintosh (MAC) laryngoscopes when employed in emergency pediatric intubation scenarios.
METHODS: This was a prospective, randomized, crossover, single-center study on novice physicians recruited on a voluntary basis. Each participant performer endotracheal intubation using Miller or Macintosh laryngoscopes during two airway scenarios: Scenario A — normal airway; Scenario B — difficult airway, defined as scenario in which the patient was placed on backboard with neck immobilization performer using rigid cervical collar. The order of use of one or other of the devices was randomized with a ratio of 1:1. The primary endpoint was the first attempt success rate.
RESULTS: The effectiveness of the first intubation attempt in Scenario B for MAC was 36.8%, for MIL — 44.7%; while in Scenario A for MAC this was 36.8%, for MIL — 44.7%. During Scenario A, the median duration time of intubation using MIL was 24.5 s [IQR; 21–32.5] and 23 s [IQR; 20.5–31] for MAC. During Scenario B, median intubation time with the MAC laryngoscope was 40.5 [IQR; 36.5–47] s, and with MIL 37.5 [IQR; 33–44.5] seconds.
CONCLUSIONS: We concluded that in trauma pediatric patients the Miller laryngoscope is associated with higher first attempt success rates than the Macintosh laryngoscope. These data suggest that for patients with cervical spine immobilization, the Miller laryngoscope should be the preferred method of intubation in emergency medicine conditions.
Abstract
INTRODUCTION: Airway management in pediatric trauma patients is challenging. Direct laryngoscopy is the gold standard for endotracheal intubation in emergency and trauma patients. The aim of the present study was to evaluate the performance of Miller (MIL) and Macintosh (MAC) laryngoscopes when employed in emergency pediatric intubation scenarios.
METHODS: This was a prospective, randomized, crossover, single-center study on novice physicians recruited on a voluntary basis. Each participant performer endotracheal intubation using Miller or Macintosh laryngoscopes during two airway scenarios: Scenario A — normal airway; Scenario B — difficult airway, defined as scenario in which the patient was placed on backboard with neck immobilization performer using rigid cervical collar. The order of use of one or other of the devices was randomized with a ratio of 1:1. The primary endpoint was the first attempt success rate.
RESULTS: The effectiveness of the first intubation attempt in Scenario B for MAC was 36.8%, for MIL — 44.7%; while in Scenario A for MAC this was 36.8%, for MIL — 44.7%. During Scenario A, the median duration time of intubation using MIL was 24.5 s [IQR; 21–32.5] and 23 s [IQR; 20.5–31] for MAC. During Scenario B, median intubation time with the MAC laryngoscope was 40.5 [IQR; 36.5–47] s, and with MIL 37.5 [IQR; 33–44.5] seconds.
CONCLUSIONS: We concluded that in trauma pediatric patients the Miller laryngoscope is associated with higher first attempt success rates than the Macintosh laryngoscope. These data suggest that for patients with cervical spine immobilization, the Miller laryngoscope should be the preferred method of intubation in emergency medicine conditions.
Keywords
endotracheal intubation, simulation, pediatric, trauma, efficacy
About this articleTitle
Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study
Journal
Disaster and Emergency Medicine Journal
Issue
Pages
1-6
Published online
2017-03-31
Page views
1001
Article views/downloads
3082
DOI
Pubmed
Bibliographic record
Disaster Emerg Med J 2017;2(1):1-6.
Keywords
endotracheal intubation
simulation
pediatric
trauma
efficacy
Authors
Marzena Wojewodzka-Zelezniakowicz
Agnieszka Madziala
Marcin Madziala
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