Comparison of 3 video laryngoscopes with the Macintosh in a manikin with easy and difficult simulated airways

Objectives: Tracheal intubation is used to maintain a patent airway and can occasionally be difficult in a potentially difficult airway, especially for novice managers. In this study, we evaluated the time required, extent of the difficulty, and number of dental clicks in the tracheal intubation for novice medical students between the Macintosh (Truphatek International Ltd, Netanya, Israel) and 3 video laryngoscopes in normal and difficult simulated intubation positions on manikins on both the table and floor.

Methods: We recruited 20 medical students as novice airway managers. They used the Macintosh, Truview (Truphatek International Ltd, Netanya, Israel), Glidescope (Verathon Inc., Bothell, WA), and Airway Scope (AWS) (Pentax Corporation, Tokyo, Japan) laryngoscopes in normal and difficult simulated airways on manikins on both the table and floor. The time to intubate, modified Cormack-Lehane score, intubation difficulty score, and dental click number were estimated and compared.

Results: All 20 medical students completed the study. The AWS required the shortest intubation time, provided the best glottic view and easiest intubation, and resulted in less dental clicks compared with the other 3 laryngoscopes; these phenomena were particularly prominent in the cervical-spine immobilization position on the floor. Although all video laryngoscopes provided better glottic views than the Macintosh laryngoscopy in terms of time to intubate, intubation difficulty score, and the number of dental clicks, the outcomes from the Macintosh laryngoscope were better than those of the Truview and Glidescope.

Conclusions: The AWS may have the potential for quicker, easier, and safer tracheal intubation in scenarios involving difficult airways for a novice airway manager.