Kleine-Brüggeney, Maren; Greif, Robert; Schoettker, P; Savoldelli, G L; Nabecker, Sabine; Theiler, Lorenz (2016). Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. British journal of anaesthesia, 116(5), pp. 670-679. Oxford University Press 10.1093/bja/aew058
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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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy |
UniBE Contributor: |
Kleine-Brüggeney, Maren, Greif, Robert, Nabecker, Sabine, Theiler, Lorenz |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0007-0912 |
Publisher: |
Oxford University Press |
Language: |
English |
Submitter: |
Jeannie Wurz |
Date Deposited: |
22 Feb 2017 09:57 |
Last Modified: |
05 Dec 2022 15:02 |
Publisher DOI: |
10.1093/bja/aew058 |
PubMed ID: |
27106971 |
Uncontrolled Keywords: |
anaesthetic techniques, laryngoscopy; equipment, airway; intubation, tracheal tube |
BORIS DOI: |
10.7892/boris.93958 |
URI: |
https://boris.unibe.ch/id/eprint/93958 |
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