Difficult airway management for novice physicians: a randomized trial comparing direct and video-assisted laryngoscopy.
OBJECTIVE
To detect a difference in (1) intubation success and (2) successful intubation times between novice physicians using a Macintosh-style or video-assisted laryngoscope on a difficult airway manikin.


METHODS
Prospective randomized trial.


METHODS
Academic, tertiary medical center.


METHODS
Forty first-year residents across a variety of disciplines with fewer than 5 total live intubations were recruited for the study. Testing took place during orientation prior to commencement of clinical duties. The entire group was provided training by faculty otolaryngologists and anesthesiologists using both laryngoscope types on a manikin airway simulator in a standard intubating scenario. Subjects were then randomized into 2 testing groups, using either a Macintosh laryngoscope or video-assisted laryngoscope in a difficult intubation scenario. The difficult airway simulation entailed oral cavity/oropharyngeal obstruction using inflation of the tongue, as well as cervical spine immobilization with a rigid collar preventing extension and elevation of the head and limiting oral cavity opening. Success was defined as a confirmed endotracheal intubation by the testing instructor in 120 seconds or less.


RESULTS
The Macintosh laryngoscope group (n = 19) had an intubation success rate of 47.4% with a mean intubation time of 69.0 seconds (95% confidence interval [CI]: 52.7, 85.2). The video-assisted group (n = 21) demonstrated a significantly higher success rate of 100% (P < .0001) and a decreased mean intubation time of 23.1 seconds (95% CI: 18.4, 27.8; P < .0001). The mean difference in success rate between groups was 52.6% (95% CI: 30.0%, 75.3%).


CONCLUSIONS
Novice physicians with little to no prior intubation experience showed significantly higher intubation success with lower intubation times using a video-assisted laryngoscope in a difficult airway manikin simulator.
Department of Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.
Art
A
Ambrosio
Travis
T
Pfannenstiel
Kevin
K
Bach
Chris
C
Cornelissen
Cory
C
Gaconnet
Matthew T
MT
Brigger
D058109:Airway Management / Q000379:methods*; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D006801:Humans; D007396:Internship and Residency; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008348:Manikins; D011446:Prospective Studies; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation*
Glidescope; emergency airway; intubation; laryngoscope; simulator