Time to intubation with McGrath™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial

Abstract

Introduction: During the COVID-19 pandemic, multiple guidelines have recommended the videolaryngoscope for tracheal intubation. However, there is no evidence that videolaryngoscope reduces time to tracheal intubation, which is important for COVID-19 patients with respiratory failure. Methods: To simulate intubation of COVID-19 patients, we randomised 28 elective surgical patients to be intubated with either the McGrath™ MAC videolaryngoscope or the direct laryngoscope by specialist anaesthetists donning 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. Primary outcome was time to intubation. Results: The median (IQR) times to intubation were 61s (37–63 s) and 41.5s (37–56 s) in the videolaryngoscope and direct laryngoscope groups respectively (p = 0.35). The closest mean (SD) distances between the anaesthetist and the patient during intubation were 21.6 cm (4.8 cm) and 17.6 cm (5.3 cm) in the videolaryngoscope and direct laryngoscope groups, respectively (p = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubation at first laryngoscopic attempt and proportion of intubations requiring adjuncts. Intubations for all the patients were successful with no adverse event. Conclusion: There was no significant difference in the time to intubation by specialist anaesthetists who were donned in PAPR and N95 masks on elective surgical patients with either the McGrath™ videolaryngoscope or direct laryngoscope. The distance between the anaesthetist and patient was significantly further with the videolaryngoscope. The direct laryngoscope could be an equal alternative to videolaryngoscope for specialist anaesthetists when resources are limited or disrupted due to the pandemic.

Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial

“…In a study conducted by Goh et al, the authors compared the McGrath VL and a DL as used by specialized anesthetists wearing PPE-AGP and N95 masks on 28 patients undergoing elective surgery. In that study, the median IT for VL (61 s) and DL (41.5 s) did not differ significantly, and they found no statistically significant differences in the FPS rate [ 25 ].…”

Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment

“…In a prospective, randomized, crossover manikin study by Yousif et al comparing a DL, GlideScope Ranger, and King Vision VL used by experienced prehospital providers wearing Level C PPE, successful ETI required significantly more time with the GlideScope Ranger (35.82 s [95% CI, 32.24–39.80 s]) than with the DL (25.69 s [95% CI, 22.42–29.42 s]; p < 0.0001) or King Vision (29.87 s [95% CI, 26.08–34.21 s]; p = 0.033), which did not differ significantly from each other ( p = 0.1017) [ 11 ]. In addition, Goh et al compared the McGrath VL and a DL as used by specialized anesthetists wearing PAPR and N95 masks in a randomized controlled trial with 28 patients undergoing elective surgery [ 12 ]. In that study, the median times to intubation for VL (61 s [37–63 s]) and DL (41.5 s [37–56 s]) did not differ significantly ( p = 0.35), and they found no statistically significant differences in the median scores on the intubation difficulty scale or FPS rate.…”

“…However, it remains unclear whether VLs are a better option than DLs while wearing cumbersome PPE, which can impede the performance of the intubator [ 8 ]. Several studies have compared DLs and VLs in a simulation context in which the intubators wore PPE; however, the findings of those studies have conflicted with one another, and clinical evidence is lacking [ 9 , 10 , 11 , 12 ].…”