Influence of videolaryngoscopy using McGrath Mac on the need for a helper to perform intubation during general anaesthesia: a multicentre randomised video-no-video trial

Abstract

Objective We hypothesised that videolaryngoscopy modifies practice of tracheal intubation. Design Randomised single-blinded study (video and no-video groups). Setting Three institutions: one academic, one non-profit and one profit. Participants Patients >18 years, requiring orotracheal intubation, without predicted difficult intubation. Non-inclusion criterion was patients requiring a rapid-sequence intubation. 300 patients were included, 271 randomised, 256 analysed: 123 in the no-video and 133 in the video groups. Intervention Tracheal intubation using a McGrath Mac videolaryngoscope, the sequence being video recorded. Primary and secondary outcome measures The primary outcome was the proportion of intubations where assistance is necessary on request of the operator. Secondary outcomes included intraoperative variables (intubation difficulty scale and its components, percentage of glottic opening score, oesophageal Intubation, duration of intubation, removal of the screen cover in the no-video group, global evaluation of the ease of intubation, bispectral index, heart rate and blood pressure), intraoperative and postoperative complications (hoarseness or sore throat) and cooperation of the anaesthesiology team. Results Requirement for assistance was not decreased in the Video group: 36.1% (95% CI 27.9 to 44.9) vs 45.5% (95% CI 36.5 to 54.7) in the no-video group, p=0.74; OR: 0.7 (95% CI 0.4 to 1.1) and absolute risk: 0.10 (95% CI −0.03 to 0.22). Intubation difficulty scale was similar in both groups (p=0.05). Percentage of glottic opening score was better in the Video group (median of 100 (95% CI (100 to 100) and 80 (95%CI (80 to 90) in the no-video group; p<0.001) as Cormack and Lehane grade (p=0001). Ease of intubation was considered better in the video group (p<0.001). Other secondary outcomes were similar between groups. Screen cover was removed in 7.3% (95% CI (2.7 to 11.9)) of the cases in the video group. No serious adverse event occurred. Communication and behaviour within the anaesthesia team were appropriate in all cases. Conclusion In patients without predicted difficult intubation, videolaryngoscopy did not decrease the requirement for assistance to perform intubation. Trial registration number NCT02926144; Results.

A Comparison of McGrath MAC, AIRWAY SCOPE®, and AceScope® Video laryngoscopes in Novice Healthcare Providers: A Randomized Crossover Simulation Study

“…Firstly, the use of a manikin model may not fully represent the complexities and challenges of intubating human subjects, particularly in di cult airway scenarios. 9,12,14,17,20,25 Therefore, the generalizability of our ndings to clinical practice should be approached cautiously. Secondly, the study only involved novice healthcare providers, and the results may not be applicable to experienced providers.…”

“…13 Sample size calculations for this study were based on previous research comparing video laryngoscopes. 9,12,14 Assuming an average intubation time of 40 seconds with a standard deviation of 10 seconds, a sample size of 7 participants per group was determined to be necessary for detecting a minimum difference of 10 seconds in intubation time between groups, with a statistical power of 0.80 and an alpha level of 0.05. To account for potential dropouts and ensure an adequate sample size for each of the three devices, the study aimed to enroll 60 novice healthcare providers, comprising both nurses and pharmacists.…”