Comparison of the McGrath ® MAC video laryngoscope with direct Macintosh laryngoscopy for novice laryngoscopists in children without difficult intubation: A randomised controlled trial

Singh

et al. 2021

Pediatric Anesthesia

Background: Various anatomical and physiological factors make intubation in infants challenging. C-MAC videolaryngoscope shows better results as compared to the conventional direct laryngoscopy for intubation in infants. McGrath MAC size-1 with a disposable Macintosh type blade has recently been introduced for use in infants and has not been formally evaluated in this population. Aims: This study aims to evaluate the intubation characteristics of C-MAC Miller and McGrath MAC in neonates and infants with the primary objective to compare the time with the two devices. Methods: After informed consent from the parents, 140 neonates and infants scheduled for surgical procedures were randomized to undergo intubation with either C-MAC Miller or McGrath MAC after standard general anesthesia. The two devices were compared in terms of total intubation time, Percent of Glottic Opening score, Cormack Lehane grades, time to glottis view, intubation difficulty score, overall success rate, first attempt success rate, and complications. Results: The median glottic view time (6 s [4-9] vs. 6 s [4-9]; p = .40) and intubation time (27 s [25.5-28] vs. 27 s [24.5-29.5]; p = .87) were similar. The mean difference (95% CI) in time to tracheal intubation and time to glottic view was 0.49 s [−3.1 to 2.1]and −1.7 s [−3.8 to 0.47], respectively. However, the Percent of Glottic Opening score, Cormack Lehane grades, and subjective intubation difficulty were significantly better with C-MAC. The first attempt success rates, overall success rates (100% vs. 97.5%), and intubation difficulty scores were comparable. There were two failed intubations with McGrath which were successfully intubated with C-MAC. Conclusion:The C-MAC Miller blade showed similar intubation timings, success rates, and intubation difficulty score as compared to McGrath MAC in neonates and infants, though the former provided superior glottic views. Both the videolaryngoscopes may be safely used in infants and neonates for routine intubation scenarios.

Section: Discussioncontrasting

confidence: 78%

Section: Intubation In Neonates and Infants Is Difficult Due To Anatomical And Physiological Reasons A Recent Retrospective Analysis Hasmentioning

confidence: 99%

Comparative efficacy of C‐MAC^® Miller videolaryngoscope versus McGrath^® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial

Singh

et al. 2021

Pediatric Anesthesia

“…In 2015, the Emergency Department of the Instituto da Criança acquired a video laryngoscope (McGrath Mac Enhanced Direct Laryngoscope; Medtronic, United Kingdom). [ 14 ] This equipment was initially used for rescue tracheal intubation attempts for children aged >1 year. [ 15 ] Since the study conducted at this institution showed that there was room for improvement in terms of intubation success at this emergency department, [ 9 ] VL was introduced as the first option for intubation in children aged >1 year, and its use was assessed prospectively.…”

Section: Introductionmentioning

confidence: 99%

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Couto¹,

Reis²,

Farhat³

et al. 2020

Medicine

The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation–associated events and desaturation among these patients. Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years. The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups ( P < .01), respectively. There was a lower proportion of tracheal intubation–associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; P = .06). The median number of attempts was 1 (range, 1–5) for the VL group and 2 (range, 1–8) for the DL group ( P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9–10.4, P < 0.01). Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation–associated events.

“…It is possible that direct laryngoscopy slowed our providers down, because one study demonstrated direct laryngoscopy to be slower than video laryngoscopy for difficult airways. 9 However, the difference is more likely due to our methodology. Our providers were required to assemble the laryngoscope, stylet and tube, inflate the cuff, and deliver a bag valve mask breath before the timing ended, whereas Getto et al's 5 residents began by picking up the C-MAC laryngoscope and ended when the tube entered the cords without any cuff inflation nor breath delivery.…”

Section: Discussionmentioning

confidence: 93%

Impact of Environmental Noise Levels on Endotracheal Intubation Performance Among Pediatric Emergency Providers

Salzman

2019

Pediatr Emer Care

Background:The emergency department is a stressful workplace environment with environmental stimuli and distractions, including noise. This has potential effects on perceived stress for providers and critical procedure performance.Objective: This study aimed to characterize the impact of environmental noise levels on the time to intubate, the quality of intubation, and physiologic stress response in pediatric emergency department providers.Methods: This was a randomized control simulation-based study in which experienced pediatric providers intubated an adult manikin 3 times while experiencing 3 different ambient noise levels (60, 75, 80 dB) in random order. Participants' times to intubate were measured, as was the endotracheal tube depth. The quality of each intubation attempt was assessed via video review against a standardized checklist. Lastly, participants' heart rates were monitored in real time to assess for physiologic stress response. Differences in performance were analyzed using a repeated-measures analysis of variance.Results: No significant difference was found between noise levels and time to intubate (P = 0.19), although each subsequent attempt shortened the time to intubate (P = 0.01). Physiological heart rate changes did not differ by noise level (P = 0.35). Subjectively, "time and economy of motion" and "overall performance" did not differ by noise level but did improve for each subsequent attempt number (P < 0.046).Conclusions: Intubation performance improved with attempt number, but no differences in performance were seen between noise levels. This suggests that rehearsing and practice impacts performance more than environmental noise levels.