Establish Whether Hyperangulated Videolaryngoscopy (HAVL) Can be Used to Facilitate Tracheal Intubation Effectively and Safely in Unselected Adult Patients; Describe the Population in Whom HAVL Fails to Facilitate Tracheal Intubation Successfully, Identifying Any Contributory Characteristics.

McGrath X-blade Study

When patients have a general anaesthetic (go to sleep for surgery), the anaesthetist often places a small tube into their windpipe (intubation) to help them breathe. To see exactly where to put the tube, the anaesthetist uses a device called a laryngoscope.

A commonly used laryngoscope is the McGrath videolaryngoscope. It has a small camera and screen to help guide safe placement of the tube. It comes in two different shapes - one shaped in the same way laryngoscopes have been shaped for the last 80 years, and another newer design (McGrath X-blade) that matches the curve of patients' tongues better.

All different classes of videolaryngoscope have been shown to have benefits to patients; however, the best videolaryngoscope shape has yet to be determined.

The McGrath X-blade is currently recommended in patients in whom the anaesthetist thinks it might be slightly more difficult to place the tube, but some anaesthetists already prefer to use it in all their patients. This is not a new device or a new technique.

In this study, the investigators wish to explore if there is any special benefit of using it in all patients, by collecting some information when the device is used.

Study Overview

• Status: Not yet recruiting
• Conditions: Intubation Complications; Intubation Skill; Intubation With Uncuffed Endotracheal Tube
• Intervention / Treatment: Device: Hyperangulated videolaryngoscopy

• Study Type: Interventional
• Enrollment (Estimated): 500
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Patrick A Ward; Phone Number: +44(0)1506523064; Email: patrick.ward@nhs.scot
• Study Contact Backup: Name: Pamela Milligan; Phone Number: +44(0)1506523064; Email: pamela.milligan@nhs.scot

Study Locations

• United Kingdom
  • Livingston, United Kingdom
    • St John's Hospital
    • Contact: Murray Geddes; Phone Number: +44(0)1506523064

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adult patients undergoing surgical procedures requiring tracheal intubation as part of their routine anaesthetic care
• Patients undergoing either naso- or oro-tracheal intubation
• Patients undergoing tracheal intubation with or without administration of neuromuscular blocking agents (e.g. those undergoing surgery where facial nerve or recurrent laryngeal nerve monitoring will be utilised)

Exclusion Criteria:

• Patients <18 years of age
• Patients in whom tracheal intubation is not required as part of their routine anaesthetic care
• Patients in whom tracheal intubation was not planned as part of their routine anaesthetic care, but was required as a rescue technique (e.g. for failed insertion of a supraglottic airway) since appropriate patient consent will not have been obtained · Patients that are physiologically unstable (where clinical care must take priority and/or patient is unable to consent for inclusion in the study)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Use of McGrath X-blade to facilitate tracheal intubation; Unselected adult patients who have been assessed as requiring tracheal intubation for their surgical intervention/ongoing care, will undergo their intubation procedure facilitated by McGrath X-blade	Device: Hyperangulated videolaryngoscopy; Hyperangulated videolaryngoscopy using McGrath X-blade

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
First-pass success	Incidence of successful tracheal intubation at the first attempt (without complications) using the McGrath-X blade	5 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall incidence of tracheal intubation success	Overall incidence of tracheal intubation success with the McGrath-X blade without complications (maximum of 3 attempts with the device)	5 minutes
Incidence of complications	Incidence of immediate airway-related complications	5 minutes

Collaborators and Investigators

• Sponsor: NHS Lothian
• Collaborators: Medtronic
• Investigators: Study Director: Patrick A Ward, NHS Lothian

Publications and helpful links

General Publications

• Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth. 2022 Oct;129(4):612-623. doi: 10.1016/j.bja.2022.05.027. Epub 2022 Jul 9.
• Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med. 2023 Aug 29;13(9):1327. doi: 10.3390/jpm13091327.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): September 1, 2027

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: May 13, 2026
• First Posted (Actual): May 20, 2026

Study Record Updates

• Last Update Posted (Actual): May 20, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: airway management; videolaryngoscopy; first-pass success; hyperangulated blade
• Other Study ID Numbers: 350850

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No