Direct versus indirect laryngoscopy using a Macintosh video laryngoscope: a mannequin study comparing applied forces

Gordon, Joanna K.; Bertram, Vaughan; Cavallin, Francesco; Parotto, Matteo; Cooper, Richard M.

doi:10.1007/s12630-020-01583-x

Cited by 17 publications

(22 citation statements)

References 20 publications

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“…Most of the VL studies compared glottis visualization, intubation success rate at overall and/or the first attempt, time to intubation, and complication, with those observed using the Macintosh laryngoscope. In many studies, VL has been reported to improve glottis visualization, increase intubation success rate, reduce intubation attempts, reduce pressure on laryngeal structures, and reduce complications compared to those observed on using the Macintosh laryngoscope [3][4][5][6][7][8][9]16]. Since the VL is evolving rapidly and has various advantages over Macintosh laryngoscope, it is considered that VL will become a routine practice in airway management during anesthesia in place of the Macintosh laryngoscope in the near future.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

Lee

Kim

et al. 2021

Anesth Pain Med

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Background: The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient.Methods: This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters.Results: Modified Cormack and Lehane grade showed significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001).Conclusions: Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.

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Section: Discussionmentioning

confidence: 99%

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

Lee

Kim

et al. 2021

Anesth Pain Med

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“…However, the search for intubation methods alternative to direct laryngoscopy is one of the main areas of research in emergency medicine. According to numerous studies, videolaryngoscopy, compared to direct laryngoscopy, shows a faster learning curve [20,21], as well as offering better glottis visibility and higher intubation efficiency, especially for intubation in difficult conditions (i.e., difficult airway conditions or difficult access to patients airway) [22,23].…”

Section: Discussionmentioning

confidence: 99%

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Gadek¹,

Szarpak

Konge

et al. 2021

JCM

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A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

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“…There is some literature discussing the utility and effectiveness of VL in the context of emergency medicine and in intensive care settings by non-expert providers. 2,5,6,8 Studies have been conducted retroactively on large patient populations and on manikins to better understand the utility of DL in the prehospital emergency setting. For example, one manikin study established that the median force applied to the concave surface of the laryngoscope during intubation attempts using VL was lower than the force applied during DL to achieve >80% of glottic opening aperture, indicating one advantage of using VL by Emergency Medical Services personnel.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

Pourmand

Terrebonne

Gerber

et al. 2022

Prehosp. Disaster med.

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Introduction: Placing an endotracheal tube is a life-saving measure. Direct laryngoscopy (DL) is traditionally the default method. Video laryngoscopy (VL) has been shown to improve efficiency, but there is insufficient evidence comparing VL versus DL in the prehospital settings. This study, comprising a systematic review and random-effects meta-analysis, assesses current literature for the efficacy of VL in prehospital settings. Methods: PubMed and Scopus databases were searched from their beginnings through March 1, 2022 for eligible studies. Outcomes were the ﬁrst successful intubation, overall success rate, and number of total DL versus VL attempts in real-life clinical situations. Cochrane’s Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess heterogeneity. Results: The search yielded seven studies involving 23,953 patients, 6,674 (28%) of whom underwent intubation via VL. Compared to DL, VL was associated with a statistically higher risk ratio for first-pass success (Risk Ratio [RR] = 1.116; 95% CI, 1.005-1.239; P = .041; I2 = 87%). The I2 value for the subgroup of prospective studies was 0% compared to 89% for retrospective studies. In addition, VL was associated with higher likelihood of overall success rate (RR = 1.097; 95% CI, 1.01-1.18; P = .021; I2 = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; P = .008). Conclusion: The meta-analysis suggested that VL was associated with higher likelihood of achieving first-pass success, greater overall success rate, and lower number of intubation attempts for adults in the prehospital settings. This study had high heterogeneity, likely presenced by the inclusion of retrospective observational studies. Further studies with more rigorous methodology are needed to confirm these results.

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Direct versus indirect laryngoscopy using a Macintosh video laryngoscope: a mannequin study comparing applied forces

Cited by 17 publications

References 20 publications

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

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