Learning Curves of Macintosh Laryngoscope in Nurse Anesthetist Trainees Using Cumulative Sum Method

Background. Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare professionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their performance of orotracheal intubation with the Macintosh laryngoscope.Methods. Eleven nurse anesthetist trainees were enrolled in the study during the first three months of their training. All trainees attended formal lectures and practice sessions with manikins at least one time on performing successful tracheal intubation under supervision of anesthesiology staff. Learning curves for each nurse anesthetist trainee were constructed with the standard cumulative summation (cusum) methods.Results. Tracheal intubation was attempted on 388 patients. Three hundred and six patients (78.9%) were successfully intubated on the trainees’ first attempt and 17 patients (4.4%) on the second attempt. The mean±SD number of orotracheal intubations per trainee was35.5 ± 5.1(range 30–47). Ten (90.9%) of 11 trainees crossed the 20% acceptable failure rate line. A median of 22 procedures was required to achieve an 80% orotracheal intubations success rate.Conclusion. At least 22 procedures were required to reach an 80% success rate for orotracheal intubation using Macintosh laryngoscope in nonexperienced nurse anesthetist trainees.

Download Full-text

Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

BioMed Research International ◽

10.1155/2015/806243 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Ryosuke Mihara ◽

Nobuyasu Komasawa ◽

Sayuri Matsunami ◽

Toshiaki Minami

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Intubation Time ◽

Direct Laryngoscope ◽

Mcgrath Mac ◽

Significant Difference ◽

Intubation Success ◽

Intubation Success Rate

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

Download Full-text

Comparison of four channelled videolaryngoscopes to Macintosh laryngoscope for simulated intubation of critically ill patients: the randomized MACMAN2 trial

Annals of Intensive Care ◽

10.1186/s13613-021-00916-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paul Decamps ◽

Nicolas Grillot ◽

Aurelie Le Thuaut ◽

Noelle Brule ◽

Corinne Lejus-Bourdeau ◽

...

Keyword(s):

Success Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Macintosh Laryngoscope ◽

Lower Boundary ◽

Random Order ◽

Orotracheal Intubation ◽

Success Rates ◽

First Pass ◽

Macintosh Laryngoscopy

Abstract Background Videolaryngoscopes with an operating channel may improve the intubation success rate in critically ill patients. We aimed to compare four channelled videolaryngoscopes to the Macintosh laryngoscope used for intubation of a high-fidelity simulation mannikin, in a scenario that simulated critical illness due to acute respiratory failure. Results Of the 79 residents who participated, 54 were considered inexperienced with orotracheal intubation. Each participant used all five devices in random order. The first-pass success rate was 97.5% [95% CI 91.1–99.7] for Airtraq™, KingVision™, and Pentax AWS200™, 92.4% [95% CI 84.2–97.2] for VividTrac VT-A100™, and 70.9% [95% CI 59.6–80.6] for direct Macintosh laryngoscopy. The first-pass success rate was significantly lower with direct Macintosh laryngoscopy than with the videolaryngoscopes (p < 0.0001 for Airtraq™, KingVision™, Pentax AWS200™, and VividTrac VT-A100™). Conclusion The Airtraq™, KingVision™, and Pentax AWS200™ channelled videolaryngoscopes produced high first-pass success rates with a lower boundary of the 95% CI above 90%. A multicentre, randomised controlled clinical study comparing channelled videolaryngoscopy to direct laryngoscopy should include one of these three videolaryngoscopes.

Download Full-text

Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

Anesthesiology Research and Practice ◽

10.1155/2011/301057 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Carlos Ferrando ◽

Gerardo Aguilar ◽

F. Javier Belda

Keyword(s):

Clinical Study ◽

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

The Other ◽

Intubation Attempt ◽

Laryngeal View ◽

Other Hand

Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score.Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq) anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared.Results. The Airtraq significantly decreased the Cormack-Lehane score (). On the other hand, there were no differences in times of laryngoscopy (; IC 95% 3.1, +4.8) and intubation (; C95% −6.1, +10.0) between the two devices. No relevant complications were found during the maneuvers of intubation using both devices.Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation.

Download Full-text

Comparison of McGrath Videolaryngoscope and Macintosh Laryngoscope in Children with Torticollis: Randomized Controlled Trial

Children ◽

10.3390/children8121171 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1171

Author(s):

Min Hur ◽

Jong Yeop Kim ◽

Sang Kee Min ◽

Kyuheok Lee ◽

Young Ju Won ◽

...

Keyword(s):

Success Rate ◽

Controlled Trial ◽

Macintosh Laryngoscope ◽

Orotracheal Intubation ◽

Difficulty Level ◽

Intubation Time ◽

Intubation Difficulty ◽

Lifting Force ◽

Lehane Grade ◽

Difficulty Scale

We investigated the efficacy of the McGrath videolaryngoscope compared with the Macintosh laryngoscope in children with torticollis. Thirty children aged 1–10 years who underwent surgical release of torticollis were randomly assigned into the McGrath and Macintosh groups. Orotracheal intubation was performed by a skilled anesthesiologist. The primary outcome was the intubation time. The Cormack–Lehane grade, lifting force, intubation difficulty scale (IDS), difficulty level, and intubation failure rate were also assessed. The intubation time was significantly longer in the McGrath group than in the Macintosh group (31.4 ± 6.7 s vs. 26.1 ± 5.4 s, p = 0.025). Additionally, the Cormack–Lehane grades were comparable between the groups (p = 0.101). The lifting force and IDS were significantly lower in the McGrath group than in the Macintosh group (p < 0.001 and p = 0.022, respectively). No significant differences were observed with respect to endotracheal intubation difficulty and intubation success rate. Intubation-related complications were also not observed. In conclusion, compared with the Macintosh laryngoscope, the McGrath videolaryngoscope extended the intubation time and did not improve glottic visualization in children with torticollis, despite having a lesser lifting force, lower intubation difficulty scale, and similar success rate.

Download Full-text

Abstract P167: Pentax-AWS is More Useful Than Macintosh Laryngoscope and Airtraq to Establish Tracheal Intubation while Uninterrupted Chest Compression: a Comparative Study with Manikin

Circulation ◽

10.1161/circ.118.suppl_18.s_1481-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jun-ichi Koyama

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Chest Compression ◽

Reporting System ◽

Macintosh Laryngoscope ◽

Spontaneous Circulation ◽

Medical Emergency ◽

Chest Compressions ◽

Compression Time ◽

Rate Of Success

Purpose. In resuscitation, chest compression is essential, and it should be performed appropriately and uninterruptedly to obtain the return of spontaneous circulation and breathing. However, attempt of tracheal intubation with the Macintosh laryngoscope (Mac) occasionally needs a temporary pause of chest compression and delays its resuming. Consequently, we studied the efficacy of the new video-laryngoscopes, PENTAX-AWS (AWS) and Airtraq (ATQ) as device used for tracheal intubation while nonstop chest compression. Materials and Methods. Twenty seven participants including 11 non-anesthetic doctors, 1 paramedic, 11 nurses and 4 medical students enrolled in this study. At first, Participants and supplementary assistant who concentrated on chest compression simulated CPR with the use of Resusci Anne Simulator manikin (Laerdal) placed on medical emergency bed as 30:2 protocol proposed in 2005 AHA Guidelines. Strength and rhythm of the compression were monitored in real-time by PC skill-reporting system. After the chest compressions became constant, participants were requested to intubate with using Mac, AWS and ATQ in both situations without chest compression and while the compression. Results. Tracheal intubation was successfully achieved within 3 attempts by 92.6% participants in Mac and 100% in AWS and ATQ without chest compression, and 66.7% in Mac, 100% in AWS and 81.5% in ATQ while chest compression. Rate of success in the 1st attempt was 55.6% in Mac, 96.3% in AWS and 51.9% in ATQ while compression. Time to intubate while compression with AWS was 14.6s, which was significantly shorter than 26.1s with ATQ in the successful attempts. Conclusions. With using AWS, high success rate of tracheal intubation was achieved even in chest compression situation in comparison with the other two devices. Macintosh laryngoscope is the most inconvenient among these devices when tracheal intubation is attempted while chest compression. ATQ showed significant decrease of success rate in compression situation despite it achieved 100% success without compression. PENTAX-AWS is expected to be more useful than Macintosh laryngoscope and Airtraq to establish tracheal intubation while uninterrupted chest compression in clinical use.

Download Full-text

Macintosh laryngoscope, i-view™, and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: A randomized, crossover, manikin study

10.21203/rs.3.rs-90522/v1 ◽

2020 ◽

Author(s):

Toshiyuki Nakanishi ◽

Yoshiki Sento ◽

Yuji Kamimura ◽

Kazuya Sobue

Keyword(s):

Intensive Care ◽

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Video Laryngoscope ◽

Interquartile Range ◽

Intubation Time ◽

Lehane Grade ◽

Significant Difference ◽

Difficulty Scale

Abstract Background: The aerosol box was designed to prevent cough droplets from spreading, but it can impede tracheal intubation. We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the i-view™ video laryngoscope (i-view) with an integrated display, or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.Methods: This prospective, randomized, crossover simulation study was conducted at an operating room of the two hospitals (a university hospital and a tertiary teaching hospital). We recruited 37 medical personnel (36 anesthesiologists and 1 dental anesthesiologist) who were working in the fields of anesthesia and intensive care with > 2 years of dedicated anesthesia experience from five hospitals. We divided the participants into six groups to use the laryngoscope in a determined order. After the training using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least two-hour intervals. The primary outcome was the intubation time. The secondary outcomes were the success rate, Cormack-Lehane grade, and subjective difficulty scale score (numeric rating scale 0–10, 0: no difficulty, 10: highest difficulty). We used the Friedman test and the Wilcoxon signed-rank test with Bonferroni adjustment. Data are shown as median [interquartile range].Results: Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P=0.247). The success rate was 95%–100% without significant difference (P=0.135). The i-view and C-MAC video laryngoscopes exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh laryngoscope; however, there were no differences between the i-view and C-MAC video laryngoscopes.Conclusions: Rapid and highly successful tracheal intubation was possible with Macintosh laryngoscope, i-view, and C-MAC video laryngoscopes on a manikin with an aerosol box. Improved Cormack-Lehane grade and ease of procedure may support the use of video laryngoscopes.Trial registration: UMIN Clinical Trials Registry, identifier UMIN000040269.

Download Full-text

A Randomized Comparison of Non-Channeled GlidescopeTM Titanium Versus Channeled KingVisionTM Videolaryngoscope for Orotracheal Intubation in Obese Patients with BMI > 35 kg·m−2

Diagnostics ◽

10.3390/diagnostics10121024 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1024

Author(s):

Tomas Brozek ◽

Jan Bruthans ◽

Michal Porizka ◽

Jan Blaha ◽

Jitka Ulrichova ◽

...

Keyword(s):

Body Mass Index ◽

Tracheal Intubation ◽

Success Rate ◽

Primary Outcome ◽

Orotracheal Intubation ◽

Obese Patients ◽

Success Rates ◽

Secondary Outcomes ◽

Postoperative Complaints

Videolaryngoscopes may improve intubating conditions in obese patients. A total of 110 patients with a body mass index > 35 kg∙m−2 were prospectively randomized to tracheal intubation using non-channeled Glidescope Titanium or channeled King Vision videolaryngoscope. The primary outcome was the time to tracheal intubation. Secondary outcomes included: total success rate, number of attempts, the quality of visualization, peri-procedural and post-proceduralcomplications. Time to the first effective breath was shorter with the King Vision (median; 95% CI)—36; 34–39 s vs. 42; 40–50 in the Glidescope group (p = 0.007). The total success rate was higher in the Glidescope group—100% vs. 89.1% (p = 0.03). There was a higher incidence of moderate and difficult laryngoscopy in the King Vision group. No difference was recorded in first attempt success rates, total number of attempts, use of additional maneuvers, intraoperative trauma, or any significant decrease in SpO2 during intubation. No serious complications were noted and the incidence of postoperative complaints was without difference. Although tracheal intubation with King Vision showed shorter time to the first breath, total success was higher in the Glidescope group, and all but one patients where intubation failed with the KingVision were subsequently intubated with the Glidescope.

Download Full-text

Learning Curves for Bag-and-mask Ventilation and Orotracheal Intubation

Anesthesiology ◽

10.1097/aln.0b013e3181d96779 ◽

2010 ◽

Vol 112 (6) ◽

pp. 1525-1531 ◽

Cited By ~ 63

Author(s):

Ryu Komatsu ◽

Yusuke Kasuya ◽

Hisanori Yogo ◽

Daniel I. Sessler ◽

Edward Mascha ◽

...

Keyword(s):

Tracheal Intubation ◽

Failure Rate ◽

Orotracheal Intubation ◽

Learning Curves ◽

Failure Rates ◽

Mask Ventilation ◽

Intubation Success ◽

Intubation Success Rate ◽

Ventilation Failure ◽

Bag And Mask Ventilation

Background In this study, the authors determined the success and failure rates for interns learning bag-and-mask ventilation and orotracheal intubation. Their goal was to determine the amount of experience needed to perform these procedures correctly. Methods The authors recorded 695 bag-and-mask ventilations and 679 orotracheal intubations performed by 15 inexperienced interns during their 3 month-long anesthesia rotations. Learning curves for each procedure for each intern were constructed with both the standard and risk-adjusted cumulative sum methods. The average number of procedures required to attain a failure rate of 20% was estimated for each technique. Results Fourteen of 15 interns attained acceptable failure rates at bag-and-mask ventilation after 27 +/- 13 procedures, with a median (95% confidence interval) of 25 (15-32) procedures to cross the decision limit when considering all 15 interns. Nine of 15 interns attained acceptable failure rates at orotracheal intubation after 26 +/- 8 procedures, with a median of 29 (22-not estimable) procedures to cross the limit when considering all interns. The proportion of interns who attained acceptable failure rates for mask ventilation was greater than for tracheal intubation (93% vs. 60%, P = 0.025). Overall, our interns achieved a bag-and-mask ventilation failure rate of 20% or better after a median of 25 procedures; approximately 80% of interns achieved the goal after 35 procedures or less. Conclusions Participating interns developed mask ventilation skills faster than orotracheal intubation skills, and there was more variability in the rate at which intubation skills developed. A median of 29 procedures was required to achieve an 80% orotracheal intubation success rate.

Download Full-text

Macintosh laryngoscope and i-view™ and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: a randomized crossover manikin study

JA Clinical Reports ◽

10.1186/s40981-021-00455-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Toshiyuki Nakanishi ◽

Yoshiki Sento ◽

Yuji Kamimura ◽

Kazuya Sobue

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Video Laryngoscope ◽

Intubation Time ◽

Care Experience ◽

Manikin Study ◽

Lehane Grade ◽

Significant Difference ◽

Difficulty Scale

Abstract Background We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the disposable i-view™ video laryngoscope (i-view) with an integrated display or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box. Methods In this randomized, crossover manikin study, we recruited 37 medical personnel with > 2 years of dedicated anesthesia experience from five hospitals. After the three successful intubations within 60 s using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least 2-h intervals in a determined order. The primary outcome was the intubation time. The secondary outcomes were success rate, Cormack-Lehane grade, and subjective difficulty scale score. Results Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P = 0.247). The success rate was 95–100%, without a significant difference (P = 0.135). The i-view and C-MAC exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh; however, there were no differences between the i-view and C-MAC. Conclusions Rapid and highly successful tracheal intubation was possible with both Macintosh, i-view, and C-MAC on a normal airway manikin in an aerosol box. Improved Cormack-Lehane grade and the ease of performing the procedure may support the use of video laryngoscopes. Trial registration UMIN Clinical Trials Registry, UMIN000040269. Registered 30 April 2020.

Download Full-text

Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00863-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jürgen Knapp ◽

Bettina Eberle ◽

Michael Bernhard ◽

Lorenz Theiler ◽

Urs Pietsch ◽

...

Keyword(s):

Emergency Medicine ◽

Quality Control ◽

Tracheal Intubation ◽

Airway Management ◽

Success Rate ◽

Video Laryngoscope ◽

Solar Irradiation ◽

Video Laryngoscopy ◽

Trauma Patients ◽

Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

Download Full-text