A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study

Szarpak, Łukasz; Truszewski, Zenon; Czyżewski, Łukasz; Gaszyński, Tomasz; Rodrı́guez-Núñez, Antonio

doi:10.1016/j.ajem.2015.11.060

Cited by 32 publications

(25 citation statements)

References 18 publications

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“…In contrast, time to intubation using the McGrath was 19.5 and 21 s for in-line manual immobilization and cervical collar, respectively. This finding supports a previous finding, that time to intubation was about 20 s, even during ongoing chest compressions [27]. …”

Section: Discussionsupporting

confidence: 93%

“…All paramedics were able to achieve improved views and quick intubation in pediatric difficult airways. We therefore conclude that videolaryngoscopy is easy to learn [6, 27]. Furthermore, the use of videolaryngoscopy is intuitive and also likely to ensure safe and effective intubations in any stressful environments such as in prehospital settings or in situations where pediatric airway experts are not available.…”

Section: Discussionmentioning

confidence: 99%

“…Important advantages of the McGrath are that providers are usually already familiar with the Macintosh blade and furthermore it allows the option of either direct or indirect view of the glottis with one line of sight [14]. Previously, the McGrath was reported to be faster and enable a higher first-attempt intubation success rate in children, even during ongoing chest compressions [26, 27]. However, whether the McGrath is effective in children with difficult airways, such as those with cervical immobilization, is unclear.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…The degree of complete chest relaxation with the TrueCPR device was 95% (IQR 76-99) and without a device it was 33% (IQR [29][30][31][32][33][34][35][36][37][38]. The difference in the degree of correctly performed chest relaxation between the tested devices was statistically significant (Fig.…”

Section: Resultsmentioning

confidence: 91%

Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study

Majer¹,

Jaguszewski

Frass

et al. 2019

Cardiol J.

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“…Many studies have shown the prevalence of videolaryngoscopy compared with direct laryngoscopy in different clinical situations [16][17][18][19]. In studies published by Szarpak et al, the use of videolaryngoscopy compared with direct laryngoscopy during endotracheal intubation in children under simulated CPR settings was associated with a higher efficiency of the first intubation attempt and a shorter procedure time [20,21]. In turn, Eisenberg et al, in a retrospective cohort study on endotracheal intubations in children aged 0-18 years in a pediatric ED between 2004 and 2014, examined 452 endotracheal intubations and which showed no difference between direct laryngoscopy and videolaryngoscopy with regard to first-pass intubation success rate, complication rate, and successful intubation rate by Emergency Department health care professionals in children undergoing endotracheal intubation in a pediatric Emergency Department…”

Section: Acknowledgementmentioning

confidence: 99%

Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study

Wojewódzka-Żelezniakowicz

Madziala²,

Madziała

2017

Disaster Emerg Med J

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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.

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A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study

Cited by 32 publications

References 18 publications

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

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

Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study

Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study

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