Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial.

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 and 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:

04 Dec 2018 15:36

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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