Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial

M Kleine-Brueggeney; R Greif; P Schoettker; G L Savoldelli; S Nabecker; L G Theiler

doi:10.1093/bja/aew058

Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial

Br J Anaesth. 2016 May;116(5):670-9. doi: 10.1093/bja/aew058.

Authors

M Kleine-Brueggeney¹, R Greif², P Schoettker³, G L Savoldelli⁴, S Nabecker², L G Theiler²

Affiliations

¹ Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern and University of Bern, Switzerland Department of Anaesthesia and Intensive Care, Barts Heart Centre, London, UK maren.kleine-brueggeney@insel.ch.
² Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern and University of Bern, Switzerland.
³ Department of Anaesthesiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland.
⁴ Division of Anaesthesiology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

PMID: 27106971
DOI: 10.1093/bja/aew058

Abstract

Background: Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway.

Methods: With ethics committee approval and written informed consent, 12 senior anaesthetists intubated the trachea of 720 patients. A cervical collar limited mouth opening and neck movement, making intubation difficult. We evaluated three unchannelled (C-MAC™ D-blade, GlideScope™, and McGrath™) and three channelled videolaryngoscopes (Airtraq™, A.P. Advance™ difficult airway blade, and KingVision™). The primary outcome was first-attempt intubation success rate. Secondary outcomes included overall success rate, laryngeal view, intubation times, and side-effects. The primary hypothesis for every videolaryngoscope was that the 95% confidence interval of first-attempt success rate is ≥90%.

Results: Mouth opening was decreased from 46 (sd 7) to 23 (3) mm with the cervical collar. First-attempt success rates were 98% (McGrath™), 95% (C-MAC™ D-blade), 87% (KingVision™), 85% (GlideScope™ and Airtraq™), and 37% (A.P. Advance™, P<0.01). The 95% confidence interval of first-attempt success rate was >90% only for the McGrath™. Overall success, laryngeal view, and intubation times differed significantly between videolaryngoscopes (all P<0.01). Side-effects were minor.

Conclusions: This trial revealed differences in the performance of six videolaryngoscopes in 720 patients with restricted neck movement and limited mouth opening. In this setting, first-attempt success rates were 85-98%, except for the A.P. Advance™ difficult airway blade. Highest success and lowest tissue trauma rates were achieved by the McGrath™ and C-MAC™ D-blade, highlighting the importance of the videolaryngoscope blade design.

Clinical trial registration: ClinicalTrials.gov: identifier NCT01692535.

Keywords: anaesthetic techniques, laryngoscopy; equipment, airway; intubation, tracheal tube.

Publication types

Comparative Study
Multicenter Study
Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anesthesia, General / methods
Double-Blind Method
Equipment Design
Female
Humans
Intubation, Intratracheal / adverse effects
Intubation, Intratracheal / instrumentation*
Intubation, Intratracheal / methods
Laryngoscopes* / adverse effects
Laryngoscopy / adverse effects
Laryngoscopy / instrumentation*
Laryngoscopy / methods
Male
Middle Aged
Prospective Studies
Video Recording
Young Adult

Associated data

ClinicalTrials.gov/NCT01692535