Background: Video laryngoscopy is a developing technology for advanced airway management. While marketed for use in hospital and prehospital settings, little is known about use of these devices in uncontrolled environments.
Objectives: We compared rates of and times to successful intubation between direct laryngoscopy (DL), King LTS-D, and four video laryngoscopes (Glidescope GVL, McGrath Series 5, Prodol AirTraq, and Storz C-MAC) in a simulated difficult airway.
Methods: Following IRB-approval, emergency physicians, emergency medicine (EM) residents, and emergency medical services (EMS) providers were enrolled. Participants were surveyed on prior experience, trained on each airway device, and given time to practice intubations with each device. Participants were allowed120 seconds to successfully place each device in a manikin airway with cervical immobilization in which simulated emesis is propelled via concealed tubing. Providers had suction, an endotracheal tube introducer, and an airway assistant available. The data were analyzed with repeated measures ANOVA.
Results: To date, 58 EMS providers have participated. Success rates: DL = 94.8%; King = 93.1%; C-MAC = 89.7%; Glidescope = 89.7%, McGrath = 58.1%, and AirTraq = 44.8%. The AirTraq and McGrath success rates were significantly lower than the others (p<0.05 for each device comparison). Average time to insertion (seconds) were: King = 27.21±19.46, DL = 38.47±20.51; C-MAC = 41.96±17.66; Glidescope = 54.74±24.32; AirTraq = 55.84±21.63; McGrath = 67.71±27.97. King LTS-D placement was significantly faster than all others (p<0.05 for all comparisons). DL placement time was significantly faster than the Glidescope, AirTraq, and McGrath (p<0.05 for all comparisons). A second phase of this study, with emergency physicians and residents, is currently underway. Data will be analyzed separately from EMS providers.
Conclusion: Interim analysis shows rates of successful placement of the Prodol AirTraq and McGrath Series were significantly lower compared to the other devices among EMS providers. In addition, the King LTS-D was the most rapidly-placed device.