Comparison of AirAngel® vs Storz® videolaryngoscope and Macintosh® laryngoscope for endotracheal intubation training: Prospective randomized crossover study

Abstract

Background: Video laryngoscopy (VL) outperforms direct laryngoscopy (DL) in both normal and difficult airway situations. However, VL seems far from being offered as a standard option in both healthcare delivery and educational activities in low-income countries, considering its high costs. Therefore, three dimensional (3D)-printed VLs may be considered an alternative to conventional VLs in low-income countries and other places with limited resources. Our objective was to compare the efficacy of AirAngel 3D-printed VL (3D-PVL) with those of commercially available Storz® VL (SVL) and conventional Macintosh® laryngoscope (MCL) in normal and difficult airway scenarios in the hands of inexperienced users. Methods: This is a prospective randomized crossover manikin study that included 126 senior medical students with no experience in intubation. The effectiveness of all three laryngoscopy devices in the hands of inexperienced users was evaluated in terms of intubation time, glottic visualization, ease of use, endotracheal tube placement and intubation success rate. Between 2020 and 2022, 126 last year medical students participated in the study. Results: MCL resulted in significantly longer intubation times than 3D-PVL and SVL in the difficult airway scenario, with no significant difference between 3DPVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction MCL: 28.54 s; SVL: 26.68 s; 3DPVL: 26.64 s). Both SVL and 3D-PVL resulted in significantly better Cormack−Lehane grades in both normal and difficult airway scenarios, and thus provided better glottic viewing than MCL, with no significant difference between 3D-PVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction, MCL: 1.73; SVL: 1.29; 3DPVL: 1.25). SVL was the easiest (1: very easy, 5: very difficult) device for normal airway scenarios, while MCL was the most difficult (MCL: 2.64; 3DPVL: 1.98; SVL: 1.49). Conversely, no significant difference was found between 3DPVL and other devices in terms of ease of use in difficult airway scenarios and in terms of accurate placement of the endotracheal tube and successful intubation attempts. Conclusion: 3D-PVL is a good educational and possible clinical alternative to conventional VL, particularly in places with limited resources, due to its low cost.