title: A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study.
abstract: BACKGROUND
  Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin.
  
  
  METHODS
  This was an open, prospective, randomized, crossover, manikin trial involving 95 paramedics who performed intubations in a PediaSIM pediatric high-fidelity manikin with Macintosh and McGrath laryngoscopes, with and without concomitant mechanical CCs. Primary outcome was the TTI, and secondary outcome was success of the attempt. Participants rated their best glottic view, the severity of the potential dental trauma, and subjective opinion about the difficulty of the procedure.
  
  
  RESULTS
  The median TTI with the Macintosh in the scenario with uninterrupted CC was 33 (interquartile range [IQR], 24-36) seconds, which is significantly longer than TTI in the scenario with interrupted CC (23 [IQR, 20-29] seconds, P < .001). Time to intubation using the McGrath was similar in both scenarios: 20 (IQR, 17-23) seconds vs 19.5 (IQR, 17-22) seconds (P = .083). A statistically significant difference between McGrath and Macintosh was noticed in TTI both in scenario with (P < .001) and without CC (P = .017).
  
  
  CONCLUSIONS
  McGrath video laryngoscope helps paramedics to intubate a pediatric manikin in a CPR scenario in less time and with fewer attempts than with the classical Macintosh, both in case of ongoing or stopped CC. McGrath use in actual patients could improve CPR quality by paramedics.
authors.affiliation: Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Szarpak
authors.affiliation: Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: zetrtrusz@gmail.com.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Truszewski
authors.affiliation: Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Czyzewski
authors.affiliation: Department of Emergency Medicine Disaster Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gaszynski
authors.affiliation: Pediatric Emergency and Critical Care Division and Institute of Investigation of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS, CLINURSID Investigation Group, Nursing Department, Universidade de Santiago de Compostela, SAMID Network, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Núñez
mesh_terms: D000488:Allied Health Personnel / Q000193:education*; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D002648:Child; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D013997:Time Factors