A randomized clinical trial comparing the King Vision (channeled blade) and the CMAC (D blade) videolaryngoscopes in patients with cervical spine immobilization

Abstract

Background and Aims: Cervical spine immobilization renders direct laryngoscopy difficult. The CMAC D blade and the channeled blade of the King Vision videolaryngoscopes, have both been used for difficult airway management. Our hypothesis is that the channeled blade of the King Vision would be superior to the CMAC D blade in terms of ease of intubation. We tested this hypothesis in a randomized comparison of the two videolaryngoscopes in patients with simulated cervical spine immobilization. Material and Methods: Hundred patients with no anticipated airway difficulty were randomly allocated to two groups after obtaining informed written consent. Following induction, manual inline stabilization (MILS) was applied to simulate a cervical spine injury and immobilzation. Patients were intubated with either of the two videolaryngoscopes. Time for visualization of the glottis, procedural time, intubation difficulty scale (IDS), and hemodynamic response were recorded. Results: The time to visualize the glottis was shorter in the CMAC D group as compared to the King Vision group (P < 0.001). The incidence of external laryngeal manipulation was less in the King Vision group (P < 0.001). The ease of intubation was superior in the King Vision group, based on the IDS (P < 0.001). The haemodynamic response was similar between the groups. Conclusion: King Vision channeled videolaryngoscope was difficult to introduce into the mouth of the patient during laryngoscopy. Once introduced into the mouth, the time for intubation was less and less external laryngeal manipulation maneuvers were performed to achieve successful intubation. The ease of endotracheal intubation was superior for the King Vision videolaryngoscope. The King Vision videolaryngoscope with proper tranining, could be a safe and portable alternative in patients with cervical spine immobilization.

Comparison between C-MAC D-blade video laryngoscope and McCoy laryngoscope for nasotracheal intubation in traumatic cervical spine surgery – A randomised controlled trial

“…This is in accordance with an earlier study on patients with a simulated cervical spine injury. [ 3 ] The exaggerated curvature of the D-blade significantly decreased the required alignment of the oropharyngeal–laryngeal axis. This blade also reduced the requirement of any additional force application during laryngoscopy.…”

“…The superiority of the C-MAC-D blade over other laryngoscopes in simulated cervical spine instability patients or manikin has been reported. [ 3 4 ]…”

Comparing the Effectiveness and Safety of MedAn with the Nishikawa Blade and UE Videolaryngoscopes for Left-Sided Double-Lumen Endobronchial Tube Intubation: A Randomized Controlled Trial

“…This study has 2 limitations: (1) the performance of the 2 videolaryngoscopes could not be compared in a double-blind study; (2) this study involved patients with normal airways at a single center, and multicenter study to comprehensively assess the performance of MedAn for difficult airways (caused, for example, by limited cervical spine movement) should be performed because different types of videolaryngoscopes should be chosen depending on the type of difficult airway [ 25 , 26 ]; and (3) a comparative study was not conducted on other video laryngoscopes (eg, McGrath MAC X-Blade and C-MAC D-Blade), but only on these 2.…”

A test prototype of a novel flexible video laryngoscope and preliminary verification in a difficult airway management simulator

“…At present, there are various visual laryngoscopes with different shapes, styles and sizes available on the market, mainly including VividTrac, Airway Scope, Airtraq, C Mac, King Vision, etc. [ 9 – 13 ]. However, the shape of the video laryngoscope blade is fixed.…”