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

Abstract

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.

Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study

“…Numerous studies indicate that in pediatric patients over 2 years of age, laryngoscopes with both Miller and Macintosh blade can be used with comparable effectiveness [36]. In turn, Eisenberg et al [10] showed that in a pediatric emergency department, the first intubation effectiveness with the use of direct laryngoscopy was only 71%.…”

The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

“…Intubation of the tracheal tube allows complete isolation of the airways, thus preventing aspiration of the alimentary tract to the respiratory tract and subsequent toxic pneumonitis [14]. It should be remembered that in out-of-hospital settings, each patient should be treated as a patient with potentially difficult airways; the patient can have a full stomach, as well as the potential to encounter anatomical anomalies in the airways.…”

“…Bielski et al [19] indicate that blind intubation is also possible in the case of traumatic patients and using other vigilant devices. In the study by Bielski et al [19], paramedics performed intubation of a patient stuck in a vehicle with a Macintosh laryngoscope and blind intubation using an iGEL laryngeal mask, achieving a significant reduction in the duration of the procedure in the case of blind intubation than direct laryngoscopy (15 [IQR,(12)(13)(14)(15)(16)(17)(18)(19) vs. 43 [IQR, 38-59], p < 0.001). In turn, Ladny et al [20] indicated that chest compressions do not affect the time necessary for blind intubation via various SADs performed by nurses.…”

Victim evacuation techniques in emergency conditions

“…There are several methods of carrying a victim on a stretcher, which depends on the number of rescuers or people who will perform this task [13]. The most atraumatic method can be used when five people are available.…”