Comparison of learning direct laryngoscopy using a McGrath videolaryngoscope as a direct versus indirect laryngoscope: a randomized controlled trial

In Kyong Yi, Jihoon Hwang, Sang Kee Min, Gang Mee Lim, Yun Jeong Chae, In Kyong Yi, Jihoon Hwang, Sang Kee Min, Gang Mee Lim, Yun Jeong Chae

Abstract

Objective: Tracheal intubation using a direct laryngoscope is difficult to teach. The McGrath videolaryngoscope, a Macintosh-like device with a camera, can be used as a direct laryngoscope to educate novices under supervision using the screen. We compared the effect on Macintosh laryngoscopy skills following training with a McGrath videolaryngoscope as a direct versus indirect laryngoscope.

Methods: Thirty-seven participants were randomized into direct and indirect groups according to the training method using a McGrath videolaryngoscope. Participants attempted Macintosh direct laryngoscopy in normal and difficult airway scenarios. The primary endpoint was the intubation time, and the rate of successful intubation, dental trauma, and difficulty were secondary outcomes.

Results: The intubation time after education decreased significantly in both groups and was significantly shorter in the direct group than in the indirect group across time. The difficulty degree in the direct group was lower than that in the indirect group across time; however, the rate of dental trauma was not significantly different.

Conclusion: Both direct and indirect laryngoscopy using a McGrath videolaryngoscope improved the performance of Macintosh direct laryngoscopy in novices, while direct laryngoscopy using a McGrath videolaryngoscope demonstrated better educational effects than indirect laryngoscopy.Registered at ClinicalTrials.gov (NCT03471975).

Keywords: Intratracheal intubation; Macintosh-like device; laryngoscope; learning; medical education; videolaryngoscope.

Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Illustrations showing how to use the McGrath videolaryngoscope as a direct vs indirect laryngoscope. In both groups, the instructor used the monitor to provide feedback. (a) Direct group: participants used the McGrath videolaryngoscope as for a Macintosh direct laryngoscope. (b) Indirect group: participants used the McGrath videolaryngoscope as an indirect videolaryngoscope, using the monitor.
Figure 3.
Figure 3.
Intubation times using a Macintosh direct laryngoscope. A0 = before education; A1 = 1st intubation attempt in a normal airway manikin scenario; A2 = 2nd intubation attempt in a normal airway manikin scenario; A3 = 1st intubation attempt in a difficult airway manikin scenario; A4 = 2nd intubation attempt in a difficult airway manikin scenario. †, significantly different compared with before education (A0) in each group; ‡, significantly different between the two groups at specific time point.
Figure 4.
Figure 4.
Degree of difficulty using a Macintosh direct laryngoscope. A0 = before education; A1 = 1st intubation attempt in a normal airway manikin scenario; A2 = 2nd intubation attempt in a normal airway manikin scenario; A3 = 1st intubation attempt in a difficult airway manikin scenario; A4 = 2nd intubation attempt in a difficult airway manikin scenario. †, significantly different compared with before education (A0) in each group; ‡, significantly different between the two groups at specific time points. NRS, numeric rating scale.

References

    1. El-Orbany M. Will direct laryngoscopy become an extinct skill? Acta Anaesthesiologica Scand. 2012; 56: 260.
    1. Sainsbury JE, Telgarsky B, Parotto M, et al.. The effect of verbal and video feedback on learning direct laryngoscopy among novice laryngoscopists: a randomized pilot study. Can J Anaesth 2017; 64: 252–259.
    1. Viernes D, Goldman AJ, Galgon RE, et al.. Evaluation of the GlideScope Direct: a new video laryngoscope for teaching direct laryngoscopy. Anesthesiol Res Pract 2012; 2012: 820961.
    1. Konrad C, Schupfer G, Wietlisbach M, et al.. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesth Analg 1998; 86: 635–639.
    1. Wang HE, Seitz SR, Hostler D, et al.. Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care 2005; 9: 156–162.
    1. Levitan RM. A new tool for teaching and supervising direct laryngoscopy. Acad Emerg Med 1996; 3: 79–81.
    1. Weiss M, Schwarz U, Dillier CM, et al.. Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy. Paediatr Anaesth 2001; 11: 343–348.
    1. Morales GA, Gilbert TB. An aid for simultaneous instructor and trainee viewing of orotracheal intubation. Anesthesiology 1991; 74: 1173–1174.
    1. Henthorn RW, Reed J, Szafranski JS, et al.. Combining the fiberoptic bronchoscope with a laryngoscope blade aids teaching direct laryngoscopy. Anesth Analg 1995; 80: 433.
    1. Howard-Quijano KJ, Huang YM, Matevosian R, et al.. Video-assisted instruction improves the success rate for tracheal intubation by novices. Br J Anaesth 2008; 101: 568–572.
    1. Wolf LE, Aguirre JA, Vogt C, et al.. Transfer of skills and comparison of performance between King Vision® video laryngoscope and macintosh blade following an AHA airway management course. BMC Anesthesiol 2017; 17: 5.
    1. Ayoub CM, Kanazi GE, Al Alami A, et al.. Tracheal intubation following training with the GlideScope compared to direct laryngoscopy. Anaesthesia 2010; 65: 674–678.
    1. Wallace CD, Foulds LT, McLeod GA, et al.. A comparison of the ease of tracheal intubation using a McGrath MAC® laryngoscope and a standard Macintosh laryngoscope. Anaesthesia 2015; 70: 1281–1285.
    1. Low D, Healy D, Rasburn N. The use of the BERCI DCI® video laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia 2008; 63: 195–201.
    1. Herbstreit F, Fassbender P, Haberl H, et al. . Learning endotracheal intubation using a novel videolaryngoscope improves intubation skills of medical students. Anesth Analg 2011; 113: 586–590.
    1. You JS, Park S, Chung SP, et al.. The usefulness of the GlideScope video laryngoscope in the education of conventional tracheal intubation for the novice. Emerg Med J 2009; 26: 109–111.
    1. Maharaj CH, McDonnell JG, Harte BH, et al.. A comparison of direct and indirect laryngoscopes and the ILMA in novice users: a manikin study. Anaesthesia 2007; 62: 1161–1166.
    1. Nouruzi-Sedeh P, Schumann M, Groeben H. Laryngoscopy via Macintosh blade versus GlideScope: success rate and time for endotracheal intubation in untrained medical personnel. Anesthesiology 2009; 110: 32–37.
    1. Woollard M, Mannion W, Lighton D, et al.. Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy. Anaesthesia 2007; 62: 1061–1065.

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