Comparison of McGrath, Pentax, and Macintosh laryngoscope in normal and cervical immobilized manikin by novices: a randomized crossover trial

Abstract

Background The aim of this study was to compare tracheal intubation performance regarding the time to intubation, glottic view, difficulty, and dental click, by novices using McGrath videolaryngoscope (VL), Pentax Airway Scope (AWS) and Macintosh laryngoscope in normal and cervical immobilized manikin models. Methods Thirty-five anesthesia nurses without previous intubation experience were recruited. Participants performed endotracheal intubation in a manikin model at two simulated neck positions (normal and fixed neck via cervical immobilization), using three different devices three times each. Performance parameters included intubation time, success rate of intubation, Cormack Lehane laryngoscope grading, dental click, and subjective difficulty score. Results Intubation time and success rate during first attempt were not significantly different between the 3 groups in normal airway manikin. In the cervical immobilized manikin, the intubation time was shorter ( p = 0.012), and the success rate with the first attempt was significantly higher ( p < 0.001) when using McGrath VL and Pentax AWS compared with Macintosh laryngoscope. Both VLs showed less difficulty score ( p < 0.001) and more Cormack Lehane grade I ( p < 0.001) in both scenarios. The incidence of dental clicks was higher with Macintosh laryngoscope compared with McGrath VL in cervical immobilized airway ( p < 0.001). Conclusions McGrath VL and Pentax AWS did not show clinically significant decrease in intubation time, however, they achieved higher first attempt success rate, easier intubation and better glottis view compared with Macintosh laryngoscope by novices in a cervical immobilized manikin model. McGrath VL may reduce the risk of dental injury compared with Macintosh laryngoscope in cervical immobilized scenario. Trial registration : ClinicalTrials.gov (NCT03161730), May 22, 2017 https://clinicaltrials.gov/ct2/hom

Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath)

“…As our primary outcome, the time to DLT intubation was chosen rather than the success rate. Similar to previous studies' findings, 27-29 the investigators assumed that the success rate would increase over the number of attempts regardless of the type of laryngoscope used. That assumption can be supported by the previous studies, which did not find a significant difference in success rates between the channeled King Vision ® VL and McGrath ® VL.…”

“…This is further supported by similar manikin studies, including novice participants that showed the mean times to endotracheal intubation ranged from 7.2 to 60 seconds using KVL and McGrath ® . 27,29,30,[32][33][34] The CUSUM charts are originally designed to detect minute changes from a given standard. These CUSUM charts have been adopted to assess the learning curve for specific clinical skills in the clinical setting.…”

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…It is intuitive to think that DL is a difficult skill to acquire and, VL must be an easier technique for novice trainees to learn. The studies of the learning protocol in normal airway and simulated difficult airway mannequin model usually results in superiority of VL over DL (e.g., better view; shorter intubation times, higher overall success rate, less dental trauma and esophageal intubation) [207][208][209][210][211][212][213][214]. Meanwhile, practicing may improve DL and VL skill competency and the rating of overall ease of use for DL/VL.…”

Educational suitability of new channel-type video-laryngoscope with AI-based glottis guidance system for novices wearing personal-protective-equipment

“…[22] In 2020, Kyong et al compared McGrath, AWS and Macintosh laryngoscopes for nurses with no intubation experience and found that McGrath and AWS appeared to be suitable equipment for novices to use compared to Macintosh laryngoscopes. [23] In 2021, Yuryo et al conducted a simulation study in novice doctors using Macintosh, McGrath, and AWS. They reported that McGrath and AWS were better equipment options for novice doctors than Macintosh in terms of laryngeal view and intubation success.…”

“…In a study comparing Macintosh laryngoscopy and AWS in 2018, Kyu et al reported to novice doctors that AWS provides a better laryngeal view faster and more easily and proposed including a video-laryngoscope in future intubation education [22] . In 2020, Kyong et al compared McGrath, AWS and Macintosh laryngoscopes for nurses with no intubation experience and found that McGrath and AWS appeared to be suitable equipment for novices to use compared to Macintosh laryngoscopes [23] . In 2021, Yuryo et al conducted a simulation study in novice doctors using Macintosh, McGrath, and AWS.…”