Tracheal intubation in the ice-pick position with video laryngoscopes: A randomised controlled trial in a manikin

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Abstract

CONTEXT

Tracheal intubation in nonstandardised positions is associated with a higher risk of tube misplacement and may have deleterious consequences for patients. Video laryngoscopes for tracheal intubation facilitate both glottic view and success rates. However, their use in the ice-pick position has not been evaluated.

OBJECTIVE

To evaluate the role of video laryngoscopes for tracheal intubation in the ice-pick position.

DESIGN

A randomised, controlled manikin trial.

SETTING

A standardised airway manikin was placed in the corner of a room. Tracheal intubation was only possible from the lower right side of the manikin. In randomised order, participants used a standard Macintosh laryngoscope and GlideScope Ranger, Storz C-MAC, Pentax AWS, Airtraq and McGrath Series5 video laryngoscopes. Statistical analysis was performed using the Wilcoxon signed-rank and McNemar's tests; A P value of less than 0.05 was deemed statistically significant.

PARTICIPANTS

Twenty anaesthesiologists, all emergency medicine board-certified.

MAIN OUTCOME MEASURES

Time to first ventilation (primary); time to glottic view and confirmation of tube position (secondary).

RESULTS

Successful ventilation was achieved most rapidly with the Macintosh laryngoscope (36.1 ± 13.4 s; reference method), followed by the Airtraq (38.4 ± 36.3 s; P = n.s.), Pentax AWS (51.6 ± 43.3 s; P = n.s.) and Storz C-Mac (62.7 ± 49.7 s; P = n.s.). The use of the GlideScope Ranger (79.8 ± 61.9 s, P = 0.01) and McGrath series5 (79.8 ± 58.5 s, P = 0.023) resulted in significantly longer times. When comparing overall intubation success, the rate of successful tracheal intubation was higher with the Airtraq than with the McGrath Series5 (P = 0.031; all others n.s.).

CONCLUSION

The use of video laryngoscopes did not result in higher success rates or faster tracheal intubation in the ice-pick position when compared with conventional laryngoscopy in this manikin study.

TRIAL REGISTRATION

www.clinicaltrials.gov, NCT01210105.

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