Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study

We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P<0.001andP=0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.

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Should the Glidescope video laryngoscope be used first line for all oral intubations or only in those with a difficult airway? A review of current literature

Journal of Perioperative Practice ◽

10.1177/1750458918788985 ◽

2018 ◽

Vol 28 (12) ◽

pp. 322-333 ◽

Cited By ~ 3

Author(s):

Terrie-Marie Russell ◽

Anil Hormis ◽

Keyword(s):

Difficult Airway ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Review Literature ◽

Video Laryngoscope ◽

Intubation Time ◽

First Line ◽

Glottic View ◽

Glidescope Video Laryngoscope ◽

Difficult Airways

The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question ‘Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?’ A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.

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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.

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A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17006392 ◽

2017 ◽

Vol 32 (4) ◽

pp. 419-423 ◽

Cited By ~ 2

Author(s):

Christopher Stein ◽

Louis Gerber ◽

Denis Curtin ◽

Nicole Oberem ◽

Mike Wells

Keyword(s):

Difficult Airway ◽

Relative Effectiveness ◽

Random Order ◽

Intubation Time ◽

Laryngoscopic View ◽

Publication Type ◽

Normal Airway ◽

Head Elevation ◽

Intubation Success ◽

The Mean

AbstractAimThe goal of this study was to compare the relative effectiveness of three adjunctive maneuvers – head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) – on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.MethodsTwenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.ResultsHead elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.ConclusionsThis study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators.SteinC, GerberL, CurtinD, OberemN, WellsM. A comparison of three maneuvers and their effect on laryngoscopic view, time to intubate, and intubation outcome by novice intubators in a simulated airway. Prehosp Disaster Med. 2017;32(4):419–423.

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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.

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Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices

PLoS ONE ◽

10.1371/journal.pone.0260140 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260140

Author(s):

Dóra Keresztes ◽

Ákos Mérei ◽

Martin Rozanovic ◽

Edina Nagy ◽

Zoltán Kovács-Ábrahám ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Difficult Airway ◽

Success Rate ◽

Endotracheal Intubation ◽

Macintosh Laryngoscope ◽

Dental Trauma ◽

Esophageal Intubation ◽

Successful Intubation ◽

Normal Airway ◽

Novice Users

Introduction Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. Materials and methods Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. Results In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. Conclusion All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.

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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.

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Comparison of Direct and Video Laryngoscopes during Different Airway Scenarios Performed by Experienced Paramedics: A Randomized Cross-Over Manikin Study

BioMed Research International ◽

10.1155/2020/5382739 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Kurt Ruetzler ◽

Lukasz Szarpak ◽

Jacek Smereka ◽

Marek Dabrowski ◽

Szymon Bialka ◽

...

Keyword(s):

Airway Management ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Cervical Collar ◽

Ease Of Use ◽

Intubation Attempt ◽

Intubation Time ◽

Management Scenarios ◽

Urgent Surgery ◽

Lehane Grade

Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine. Aim. The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios. Methods. This prospective cross-over simulation study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. Results. In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16–21) for MAC, 18 s (IQR: 16–21) for McGrath, and 27 s (IQR: 23–34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p<0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p<0.001). Intubation time was 21 s (IQR: 19–29) for MAC, 18 s (IQR: 18–24.5) for McGrath, and 30 s (IQR: 23–39) for PCD. In scenario D, the success rate with MAC was 32%, 69% with McGrath, and 58% with PCD (p<0.001). Intubation time was 26 s (IQR: 20–29) for MAC, 26 s (IQR: 20–29) for McGrath, and 45 s (IQR: 33–56) for PCD. In scenario E, the success rate with MAC was 32%, but 64% with McGrath and 62% with PCD (p<0.001). Intubation time was 28 s (IQR: 25–39) for MAC, 19 s (IQR: 18–26) for McGrath, and 34 s (IQR: 27–45) for PCD. Conclusions. The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.

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A Comparison of the GlideScope® with the Macintosh Laryngoscope for Tracheal Intubation in Patients with Simulated Difficult Airway

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300215 ◽

2005 ◽

Vol 33 (2) ◽

pp. 243-247 ◽

Cited By ~ 70

Author(s):

Y. Lim ◽

S. W. Yeo

Keyword(s):

Tracheal Intubation ◽

Difficult Airway ◽

Controlled Trial ◽

Macintosh Laryngoscope ◽

Good Alternative ◽

Intubation Time ◽

Laryngeal View ◽

Lehane Grade ◽

Primary Hypothesis ◽

Written Informed Consent

We compared the use of the GlideScope® and the conventional Macintosh laryngoscope in a simulated difficult airway. The primary hypothesis was that time to intubation would be shorter using the GlideScope® than using the Macintosh laryngoscope. After obtaining approval from the ethics committee and written informed consent, we recruited 60 ASA 1 and 2 patients to our randomized controlled trial. Group G (n=30) had tracheal intubation performed using the GlideScope® and Group M (n=30) were intubated using a Macintosh laryngoscope. We simulated a difficult airway in each patient by having an experienced assistant provide in-line manual stabilization of the head and neck. We recorded the best laryngeal view; difficulty of the tracheal intubation; time taken for successful tracheal intubation; manoeuvre needed to aid tracheal intubation and complications associated with the tracheal intubation. The median Cormack and Lehane grade was significantly better in Group G than Group M. Group G had a significantly shorter intubation time than group M (mean 41.8s±SD 20.2 vs mean 56.2s±26.6, P<0.05). The GlideScope® improved the laryngeal view and decreased time for tracheal intubation time when compared with the Macintosh laryngoscope in patients with simulated difficult airway. The GlideScope® may be a good alternative for managing the difficult airway but clinical trials evaluating its use on patients with an actual difficult airway are needed.

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Systematic Review Comparison of Endotracheal Intubation Success Rate Using McGrath® Mac Videolaryngoscope with Direct Laryngoscope (Macintosh): A Manikin Studies

Indonesian Journal of Anesthesiology and Reanimation ◽

10.20473/ijar.v3i12021.22-33 ◽

2021 ◽

Vol 3 (1) ◽

pp. 22

Author(s):

Dicha Niswansyah Auliyah ◽

Prananda Surya Airlangga ◽

Lilik Herawati

Keyword(s):

Systematic Review ◽

Difficult Airway ◽

Success Rate ◽

Endotracheal Intubation ◽

Medical Personnel ◽

Learning Material ◽

Screening Process ◽

Direct Laryngoscope ◽

Normal Airway ◽

Intubation Success Rate

Introduction: McGrath® MAC videolaryngoscope is a single-handed device designed to facilitate intubation in patients both in patients with normal airway conditions (without any complications) or airway conditions with complications such as cervical spine and/or anatomic abnormalities. Objective: This study aims to compare McGrath® MAC videolaryngoscope and direct laryngoscope using Macintosh blades as learning material or study simulators for medical personnel (including anesthesiologist and paramedics) and novice operator (medical students). Method: this study is a systematic review using the PRISMA method which was carried out systematically. Data was collected through Pubmed, direct science, EBSCOHost, and Proquest using the keywords ‘airway management ', ‘laryngoscopy', and 'manikin'. Journal included based on published publication time between 2008 and 2020, a study using SimMan Laerdal Airway manikin, a journal discussing intubation using McGrath® MAC videolaryngoscope and direct laryngoscope with Macintosh blades here, where it is normal airway (without complications) and difficult airway. Results: 1556 journals were collected through 4 journal search sites and then carried out a screening process for the publication year approved in 2008 to 2020. Four studies use adult manikin SimMan Laerdal Airway including 247 participants were included in this systematic review. Conclusion: Based on journals that have been reviewed, McGrath® MAC videolaryngoscope provides better and superior results compared to Macintosh in terms of the success rate and visualization of glottis. Also, the intubation time using McGrath® MAC videolaryngoscope is shorten compared to Macintosh both on the normal airway (without complication) and difficult airway. The participants (medical personnel and novice operators) in all studies that reviewed prefer to use McGrath® Mac videolaryngoscope instead of using direct laryngoscope with Macintosh blade for Endotracheal Intubation mainly used for learning or study simulators.

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A Case of Successful Tracheal Tube Exchange With McGrath MAC for Tube Damage During Oral Surgery

Anesthesia Progress ◽

10.2344/anpr-67-02-01 ◽

2020 ◽

Vol 67 (3) ◽

pp. 174-176

Author(s):

Yuko Koyanagi ◽

Eiko Yokota ◽

Marina Iwata ◽

Ritsuko Shimazaki ◽

Toru Misaki ◽

...

Keyword(s):

General Anesthesia ◽

Difficult Airway ◽

Endotracheal Tube ◽

Oral Surgery ◽

Maxillary Osteotomy ◽

Mcgrath Mac ◽

Lehane Grade ◽

Tube Exchange ◽

Nasotracheal Tube ◽

Grade 3

A patient undergoing a bilateral sagittal split and LeFort 1 maxillary osteotomy performed under general anesthesia required emergent intraoperative exchange of a potentially damaged nasotracheal tube. This exchange was smoothly performed under constant indirect visualization using the McGrath MAC video laryngoscopy system. After the exchange, ventilation of the patient dramatically improved. The removed endotracheal tube was torn 19 cm from the distal tip. The McGrath MAC was useful for visualizing the glottis and confirming the entire course of the tube exchange despite the patient's having a difficult airway (Cormack-Lehane grade 3).

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