Airway Management during Massive Gastric Regurgitation Using VieScope or Macintosh Laryngoscope—A Randomized, Controlled Simulation Trial

Abstract

In this model of massive gastric aspiration, we compared two different laryngoscopes (VieScope and Macintosh) in a randomized, controlled simulation study. The primary endpoint was time to intubation; the secondary endpoints were intubation success (i.e., tracheal tube position) and amount of pulmonary aspiration. Thirty-four anesthetists performed endotracheal intubation using VieScope and Macintosh laryngoscopy in a randomized order on an airway manikin simulating massive regurgitation of gastric fluid. The primary endpoint “time until intubation” could be achieved significantly faster (mean −12.4 s [95% confidence intervals (CI) −19.7 s; −7.3 s]) with Macintosh compared to VieScope (p < 0.001). Concerning “correct tube position”, no statistical difference was found between the devices (p = 1.0). The mean time to first ventilation was −11.1 s [95% CI −18.3 s; −5.3 s] when using Macintosh (p = 0.001). The mean volume of aspirated gastric fluid was lower in the Macintosh group: −90.0 mL [95% CI −235.0 mL; −27.5 mL] (p = 0.011). Data from this simulation study suggest that in a model of massive gastric regurgitation, airway management can be achieved faster and with less gastric aspiration when using a Macintosh laryngoscope compared to a VieScope laryngoscope.

A comparison of tracheal intubation using intubrite laryngoscope and conventional MAC laryngoscope: An open, prospective, crossover manikin study

“…[5] Over the years many variants of direct laryngoscopes with following blades were developed: Miller (1941), Macintosh (1943), Soper (1947), Jackson-Wisconsin (1952), Bizzari-Guffrid (1958), Bainton (1987), and recently VieScope laryngoscope, but until now primarily used remained the oldest 2: Macintosh and Miller, with vast majority of Macintosh blade. [8,9] Nowadays its role in difficult airways visualization in adult patients is largely limited to Macintosh and MacCoy laryngoscopes. [5] McCoy laryngoscope which was introduced into clinical practice in 1993 is the laryngoscope with Macintosh like blade and the tip which bends upon pressing the lever to further lift the epiglottis.…”

Is older still good, or even better? Evaluation of possibility of using Miller laryngoscope for intubation in adults and comparison with the most widely used Macintosh laryngoscope. Protocol of a crossover randomized control trial

“…However, those researchers did not compare Miller blade with Macintosh blade in the same patients, they also did not demonstrate which blade would be better in particular patient. Many authors believe that the Miller blade provides better visibility of the glottis than the Macintosh blade [ [11] , [12] ]. According to Arino, the Miller blade allows for 96 % of the best visibility of the glottis, while in the case Macintosh blade this percentage drops to 72 % [ 8 ].…”

A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial

“…Ecker et al published a study regarding the use of VieScope in the adult population in a randomized, controlled simulation study evaluating time to intubation and the intubation success and extension of pulmonary on an airway manikin simulating massive regurgitation of gastric fluid [ 18 ]. It has been shown that laryngoscopy using Macintosh can provide faster airway management with less gastric aspiration compared to VieScope.…”

“…Ecker et al also compared VieScope Glidescope, Glidescope, and conventional Macintosh laryngoscopy in a simulated randomized controlled simulation trial in a difficult airway situation [ 18 ]. Those authors concluded that the correct tracheal tube position rate was comparable between the three devices.…”