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Comparative Study
. 2016 Oct 24;6(10):e011089.
doi: 10.1136/bmjopen-2016-011089.

Efficacy of various types of laryngoscope (direct, Pentax Airway Scope and GlideScope) for endotracheal intubation in various cervical immobilisation scenarios: a randomised cross-over simulation study

Jong Won Kim  1 , Kyeong Ryong Lee  1 , Dae Young Hong  1 , Kwang Je Baek  1 , Young Hwan Lee  2 , Sang O Park  1
Affiliations
Comparative Study

Efficacy of various types of laryngoscope (direct, Pentax Airway Scope and GlideScope) for endotracheal intubation in various cervical immobilisation scenarios: a randomised cross-over simulation study

Jong Won Kim et al. BMJ Open. .

Abstract

Objective: To compare the efficacy of direct laryngoscopy (DL), Pentax Airway Scope (PAWS) and GlideScope video laryngoscope (GVL) systems for endotracheal intubation (ETI) in various cervical immobilisation scenarios: manual in-line stabilisation (MILS), Philadelphia neck collar (PNC) (moderate limit of mouth opening) and Stifneck collar (SNC) (severe limit of mouth opening).

Design: Randomised cross-over simulation study.

Setting and participants: 35 physicians who had >30 successful ETI experiences at a tertiary hospital in Seoul, Korea.

Primary and secondary outcome measures: Participants performed ETI using PAWS, GVL and DL randomly in simulated MILS, PNC and SNC scenarios in our simulation centre. The end points were successful ETI and the time to complete ETI. In addition, modified Cormack-Lehane (CL) classification and pressure to teeth were recorded.

Results: In MILS, there were no significant differences in the rate of success of ETI between the three devices: 33/35(94.3%) for DL vs 32/35(91.4%) for GVL vs 35/35(100.0%) for PAWS; p=0.230). PAWS achieved successful ETI more quickly (19.8 s) than DL (29.6 s) and GVL (35.4 s). For the PNC scenario, a higher rate of successful ETI was achieved with GVL 33/35 (94.3%) than PAWS 29/35 (82.9%) or DL 25/35 (71.4%) (p=0.040). For the SNC scenario, a higher rate of successful ETI was achieved with GVL 28/35(80.0%) than with DL 14/35(40.0%) and PAWS 7/35(20.0%) (p<0.001). For the PNC and SNC scenarios, GVL provided a relatively good view of the glottis, but a frequent pressure to teeth occurred.

Conclusions: All three devices are suitable for ETI in MILS. DL is not suitable in both neck collar scenarios. PAWS showed faster intubations in MILS, but was not suitable in the SNC scenario. GVL is most suitable in all cervical immobilisation scenarios, but may cause pressure to teeth more frequently.

Keywords: cervical stabilization; direct laryngoscopy; tracheal intubation; video laryngoscopy.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the study.
Figure 2
Figure 2
Kaplan-Meier analysis of cumulative endotracheal intubation success rate using direct laryngoscopy, GlideScope and Pentax AWS in various cervical immobilisation scenarios: manual in-line cervical stabilisation, Philadelphia neck collar and Stifneck collar. ETI, endotracheal intubation; MILS, manual in-line stabilisation.
Figure 3
Figure 3
Graphs of Modified Cormack-Lehane classifications of endotracheal intubation using direct laryngoscopy, GlideScope and Pentax AWS in various cervical immobilisation scenarios: manual in-line cervical stabilisation, Philadelphia neck collar and Stifneck collar. Pentax AWS, Pentax Airway Scope.
See this image and copyright information in PMC

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