First-Attempt Intubation Success of Video Laryngoscopy in Patients with Anticipated Difficult Direct Laryngoscopy

Abstract

Head-to-head comparison in this large multicenter trial revealed that the newly introduced C-MAC D-Blade does not yield the same first-attempt intubation success as the GlideScope in patients with predicted difficult laryngoscopy except in the hands of attending anesthesiologists. Additional research would be necessary to identify potential causes for this difference. Intubation success rates were very high with both systems, indicating that acute-angle video laryngoscopy is an exceptionally successful strategy for the initial approach to endotracheal intubation in patients with predicted difficult laryngoscopy.

Current Evidences for the Use of UEscope in Airway Management

“…[11] The Storz D-Blade VL is more acutely angulated than Glidescope device, and the optical component is carried more distally than it is on Glidescope device. [12] The sharply angled blade is helpful to insert the device around the anatomic curve of the upper airway and to provide an improved laryngeal visualization by seeing “around the corner” in difficult airway situations. [13] In fact, Glidescope, McGrath, and Storz D-Blade VLs are specially designed for managing difficult airways.…”

“…[16] Furthermore, the difference in their projected video images may present a challenge for tube passage for some intubators when using Storz D-Blade VL, particularly for those who are more experienced with the more proximal lens location of Glidescope device. [12] Since the video lens of Storz D-Blade VL is very close to the tip of the blade, it is also more difficult to position the tracheal tube in front of the glottis. [14] When tracheal intubation is performed with sharply angulated VLs, thus, the ability to expose the larynx does not correlate with successful intubation, i.e., difficulty in passing the tube into the trachea through the glottis is a frequently troublesome problem.…”

“…[12] However, when patient is already anesthetized and the intubation with a VL fails, only a limited number of options remain and no uniformity of strategy to manage VL failure is recommended. The available evidence supports the usefulness of combined VL and other devices (including tube introducer, fiber optic bronchoscope [FOB], Bonfils intubation fiberscope, and Boedeker intubation forceps) in such difficult conditions.…”

Videolaryngoscopy post COVID-19

“…These benefits become increasingly relevant when dealing with COVID-19 patients, where intubation poses a high risk of transmission to healthcare providers involved in the procedure and where time to securing the airway is critical to the wellbeing of the patient [ 1 , 3 , 10 ]. Evidence supports videolaryngoscopes as a rescue device when difficult intubation is encountered and direct laryngoscopy has been unsuccessful [ 11 ]. As most difficult intubations are unanticipated, routine use of a videolaryngoscope eliminates the delay in changing equipment when a difficult intubation does occur and trains providers for the critical event.…”

Anesthesiology and the difficult airway - Where do we currently stand?

“…There are many reports of their successful use during difficult airway care. [ 11 12 ] A recent Cochrane review reports that video laryngoscopes improve the glottis view and may reduce the number of failed intubations, particularly in patients presenting with a difficult airway. Despite this, there is no current evidence that use of a video laryngoscope reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications.…”