title: Tracheal intubation in the ice-pick position with video laryngoscopes: a randomised controlled trial in a manikin.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A randomised, controlled manikin trial.
  
  
  METHODS
  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.
  
  
  METHODS
  Twenty anaesthesiologists, all emergency medicine board-certified.
  
  
  METHODS
  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.).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  www.clinicaltrials.gov, NCT01210105.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. wolfgang.wetsch@uk-koeln.de
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wetsch
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Oliver
authors.initials: O
authors.lastname: Spelten
authors.forename: Robert
authors.initials: R
authors.lastname: Schier
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Jochen
authors.initials: J
authors.lastname: Hinkelbein
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D014741:Video Recording