Using direct laryngoscopy (DL) using a Macintosh blade is the traditional, standard technique for endotracheal intubation. Over the last decade, the frequency of video laryngoscopy (VL) use has increased within anesthesiology, as well as in situations when unexpected difficulties inhibit DL or a second attempt is needed. However, available research on the value of VL versus DL is limited. For a study presented at the 2019 World Airway Management Meeting, Rudy Noppens, MD, PhD, and colleagues sought to determine the rate of first-pass success (FPS) with VL when compared with DL. “We hypothesized that using a VL would be associated with reduced number of intubation attempts,” explains Dr. Noppens.

The study was an international multi-center randomized clinical trial with more than 2,000 participants scheduled for elective surgery with endotracheal intubation. Participants received either a standard direct laryngoscopy or the McGrath MAC video laryngoscope using Macintosh blades. The main trial focus was rate of FPS, with secondary interests in provider experience, time to intubate, intubation difficulty score (IDS), and adverse events.

The DL performed as the research team expected, with an 82% FPS rate, whereas VL performed better than hypothesized, with a 94% FPS rate. Time for intubation was shorter for DL when compared with VL (34 vs 36 seconds). The IDS was higher (>5) with use of DL (5.6%) than with VL (1.2%). No significant differences in adverse events were observed.  “Our results show that using the video laryngoscope was associated with 1 second longer time for placement,” adds Dr. Noppens. “This was statistically significant, but is clinically irrelevant. Based on these results, video laryngoscopy using a Macintosh-shaped blade can be recommended as a first choice instrument in elective surgery patients.

Dr. Noppens emphasizes that only anesthesiologists in a controlled OR environment participated in the trial. “Results cannot be automatically transferred to acute care settings or to different healthcare professionals,” he says. “All participants were trained in endotracheal intubation and had pre-existing experience in laryngoscopy. Our results underline that with the availability of VL, the use of traditional laryngoscopy can be replaced with the more novel device.”