title: Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial.
abstract: BACKGROUND
  The aim of the present study was to evaluate whether different video laryngoscopes (VLs) facilitate endotracheal intubation (ETI) faster or more secure than conventional laryngoscopy in a manikin with immobilized cervical spine.
  
  
  METHODS
  After local ethics board approval, a standard airway manikin with cervical spine immobilization by means of a standard stiff collar was placed on a trauma stretcher. We compared times until glottic view, ETI, cuff block and first ventilation were achieved, and verified the endotracheal tube position, when using Macintosh laryngoscope, Glidescope Ranger, Storz C-MAC, Ambu Pentax AWS, Airtraq, and McGrath Series5 VLs in randomized order. Wilcoxon signed-rank test and McNemar's test were used for statistical analysis; p<0.05 was considered as significant.
  
  
  RESULTS
  Twenty-three anaesthetists (mean age 32.1±4.9 years, mean experience in anaesthesia of 6.9±4.8 years) routinely involved in the management of multitrauma patients participated. The primary study end point, time to first effective ventilation, was achieved fastest when using Macintosh laryngoscope (21.0±7.6s) and was significantly slower with all other devices (Airtraq 33.2±23.9 s, p=0.002; Pentax AirwayScope 32.4±14.9 s, p=0.001; Storz C-MAC 34.1±23.9 s, p<0.001; McGrath Series5 101.7±108.3 s, p<0.001; Glidescope Ranger 46.3±59.1 s, p=0.001). Overall success rates were highest when using Macintosh, Airtraq and Storz C-MAC devices (100%), and were lower in Ambu Pentax AWS and Glidescope Ranger (87%, p=0.5) and in McGrath Series5 device (72.2%, p=0.063).
  
  
  CONCLUSIONS
  When used by experienced anaesthesiologists, video laryngoscopes did not facilitate endotracheal intubation in this model with an immobilized cervical spine in a faster or more secure way than conventional laryngoscopy. However, data was gathered in a standardized model and further studies in real trauma patients are desirable to verify our findings.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wetsch
authors.forename: Oliver
authors.initials: O
authors.lastname: Spelten
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Martin
authors.initials: M
authors.lastname: Carlitscheck
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Padosch
authors.forename: Heiko
authors.initials: H
authors.lastname: Lier
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Jochen
authors.initials: J
authors.lastname: Hinkelbein
mesh_terms: D000328:Adult; D000758:Anesthesia; D002574:Cervical Vertebrae; D002983:Clinical Competence; D018592:Cross-Over Studies; D004630:Emergencies; D005260:Female; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D007828:Laryngoscopy; D008297:Male; D008348:Manikins; D014741:Video Recording