Effect of the McGRATH MAC® Video Laryngoscope on Hemodynamic Response during Tracheal Intubation: A Retrospective Study

Introduction: Tracheal intubation using video laryngoscopes has been a better approach for trauma patients requiring cervical immobilisation. The aim of this study was to compare the time to successful intubation by novice intubators using three types of intubation stylets with the new McGrath MAC video laryngoscope in a manikin model. Methods: This was a randomised crossover manikin study. The participants performed tracheal intubations using three intubation stylets (arcuate shape malleable stylet, McGrath MAC-shaped malleable stylet and McGrath MAC-shaped rigid stylet) in a difficult airway model with cervical immobilisation. The order of the stylets was randomised. The primary outcome was the time to successful intubation. The secondary outcomes were the overall success rates, incidence of dental trauma and ease of intubation. All intubation attempts were assessed by trained assistants. The data were analysed using a multilevel model followed by Tukey’s post hoc test. Results: A total of 68 nurses participated in this study. The time to successful intubation of the McGrath MAC-shaped malleable stylet was significantly shorter than that of the arcuate shape malleable stylet (24.5 (18.0–51.0) s vs 31.5 (21.0–89.0) s, p = 0.005). The overall success rate of the McGrath MAC-shaped malleable stylet was also higher than that of the arcuate shape malleable stylet ( p = 0.047). The participants indicated that intubation was easier using the McGrath MAC-shaped malleable stylet compared with the other stylets. Conclusion: The McGrath MAC-shaped malleable stylet, when used by novice intubators, may be an optimal stylet shape for tracheal intubation using the McGrath MAC in cervical immobilisation.

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Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol

BMJ Open ◽

10.1136/bmjopen-2017-016907 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016907 ◽

Cited By ~ 1

Author(s):

Marc Kriege ◽

Christian Alflen ◽

Irene Tzanova ◽

Irene Schmidtmann ◽

Tim Piepho ◽

...

Keyword(s):

Tracheal Intubation ◽

Direct Laryngoscopy ◽

Case Reports ◽

Controlled Trial ◽

Macintosh Laryngoscope ◽

Video Laryngoscope ◽

Successful Intubation ◽

First Choice ◽

Mcgrath Mac ◽

First Pass

IntroductionThe direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients.Methods and analysisThe EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications.Ethics and disseminationThe project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings.Trial registration numberClinicalTrials.gov NCT 02611986; pre-results.

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Comparison of three types of intubation stylets for tracheal intubation with McGRATH MAC video laryngoscope by novice intubators in a simulated cervical spine immobilization: A randomized crossover manikin study

Resuscitation ◽

10.1016/j.resuscitation.2014.03.077 ◽

2014 ◽

Vol 85 ◽

pp. S27-S28

Author(s):

Ji-Hoon Kim ◽

Sung-Wook Kim ◽

Young-Min Kim

Keyword(s):

Cervical Spine ◽

Tracheal Intubation ◽

Video Laryngoscope ◽

Manikin Study ◽

Mcgrath Mac

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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.

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