A comparison of McGrath MAC® and standard direct laryngoscopy in simulated immobilized cervical spine pediatric intubation: a manikin study

Abstract

Emergency airway management in children is generally considered to be challenging, and endotracheal intubation requires a high level of personal skills and experience. Immobilization of the cervical spine is indicated in all patients with the risk of any cervical spine injury but significantly aggravates endotracheal intubation. The best airway device in this setting has not been established yet, although the use of videolaryngoscopes is generally promising. Seventy-five moderately experienced paramedics of the Emergency Medical Service of Poland performed endotracheal intubations in a pediatric manikin in three airway scenarios: (A) normal airway, (B) manual in-line cervical immobilization, and (C) cervical immobilization using a Patriot cervical extrication collar and using two airway techniques: (1) McGrath videolaryngoscope and (2) Macintosh blade in a randomized sequence. First-attempt intubation success rate, time to intubation, glottis visualization, and subjective ease of intubation were investigated in this study. Intubation of difficult airways, including manual in-line and cervical collar immobilization, using the McGrath was significantly faster, with a higher first-attempt intubation success rate, better glottic visualization, and ease of intubation, compared to Macintosh-guided intubation. In the normal airway, both airway techniques performed equal. Conclusion: Our manikin study indicates that the McGrath may be a reasonable first intubation technique option for endotracheal intubation in difficult pediatric emergencies. Further clinical studies are therefore indicated. What is known : • Airway management in pediatrics is challenging and requires a high level of skills and experience. Cervical immobilization is indicated in all patients with any risk of cervical spine injury, but it significantly aggravates endotracheal intubation in these patients. Videolaryngoscopes have been reported to ease intubation and provide better airway visualization in the regular clinical setting. What is new: • The McGrath is an easy-to-use and clinically often used videolaryngoscope, but it has never been investigated in pediatrics with an immobilized cervical spine. In the normal airway, the McGrath provided better airway visualization compared to Macintosh laryngoscopy. However, better visualization did not lead to decreased time to intubation and a higher success rate of the first intubation attempt. In difficult airways, the McGrath provided better airway visualization and this led to faster intubation, a higher first-attempt intubation success rate, and better ease of intubation compared to Macintosh-guided intubation.

Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

“…In the case of direct laryngoscopy, the learning curve, as shown by numerous studies, illustrates 43-75 attempts required for achieving successful intubation (34)(35)(36). The present study indicates an acceleration of the learning curve with videolaryngoscopy, and this is also confirmed in studies by Baciarello et al (37), Aghamohammadi et al (38), and other authors (13,39,40).…”

Comparison of Macintosh Laryngoscope and GlideScope® for Orotracheal Intubation in Children Older Than One Year

“…According to the VAS score, we did not find any superiority for ease of intubation as in the literature [20][21][22].…”

Novel airway device Vie Scope in several pediatric airway scenario

“…Previous studies investigating several videolaryngoscopes including the McGrath and the Trueview demonstrated relatively shorter time to intubation during CPR. [ 26 , 27 ] This relatively longer time to intubation for the VieScope is based on the technique, as the VieScope includes 2 separate steps—introducing the bougie between vocal cords and the endotracheal tube vie the bougie into the trachea. However, our intubation times are broadly in keeping with a recent randomized clinical trial, comparing intubation with bougie and endotracheal tube with stylet in adult emergency settings.…”