GlideScope versus McCoy laryngoscope: Intubation profile for cervically unstable patients in critical care setting

Abstract

Background: Endotracheal intubation for cervically unstable patients remains a challenging procedure. We compared the utility of a relatively new promising airway tool ''GlideScope" (GL) with the routinely used McCoy laryngoscope in our critical care unit. Methods: Forty intubated patients with suspected or proved cervical spine injury who were scheduled for replacing a conventional endotracheal tube (ETT) by ETT with subglottic suction facility were enrolled in this randomized controlled trial. Patients were randomly intubated using either GL ''G group" or McCoy laryngoscope ''M group". The first attempt was performed by anesthetic residents inexperienced in using both scopes. In case of failure, a second attempt was done by a consultant anesthetist using these tools masterly. If these two attempts failed to intubate the trachea, a third one was attempted using a fiberoscope by the same consultant anesthetist. We compared the intubation profiles of both scopes. Results: There was a higher success rate of primary intubation attempts among the G group population (85% versus 55% in the M group ''P value 0.03"). Moreover, all secondary intubation attempts succeeded in intubating the trachea. The mean time for primary intubation attempts was statistically longer in the M group (27.6 ± 2.7 S versus 19.8 ± 5.2 S in the G group ''P value < 0.001"). However, there was no statistical difference as regards the mean time of intubation among the study population during the secondary intubation attempts. The Cormack and Lehane score and the percentage of required optimization maneuvers were significantly higher in the M group for both attempts. Conclusion: In critical care setting, GL is an excellent primary intubating tool for patients with potential cervical spine instability even if being performed by inexperienced users.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…256,266 Randomized controlled trials reported equivocal findings for laryngoscopic view, intubation success, first attempt intubation success, and time to intubation when hyperangulated videolaryngoscopes were compared with nonangulated videolaryngoscopes for anticipated difficult airways (Category A2-E evidence). 257,259 Observational studies indicated intubation success rates for videolaryngoscopes ranging from 85 to 100% of patients [267][268][269][270][271][272][273][274][275] and first attempt successful intubation rates ranging from 51 to 100% 267,269,[271][272][273][274][275] (Category B3-B evidence). Case reports observed videolaryngoscope intubation successes with a wide range of difficult airway conditions (Category B4-B evidence).…”

“…Observational studies indicated intubation success rates for videolaryngoscopes ranging from 85 to 100% of patients 267–275 and first attempt successful intubation rates ranging from 51 to 100% 267,269,271–275 (Category B3-B evidence ). Case reports observed videolaryngoscope intubation successes with a wide range of difficult airway conditions (Category B4-B evidence ).…”