Available online 17 November 2023, 101313

Author links open overlay panel, , , , , , AbstractIntroduction

Direct laryngoscopy is the most widely used procedure for learning intubation. Video-laryngoscopy has become a well-established tool in managing of difficult laryngoscopies. Its contribution to teaching intubation for novices remains unclear.

The aim of this study was to compare video-laryngoscopy using Medcaptain® laryngoscope and direct laryngoscopy using Macintosh laryngoscope in learning tracheal intubation on a low-fidelity manikin by novice learners.

Methods

This was a cross-sectional, randomized, cross-over study, including 35 inexperienced in laryngoscopy students in the 5th year of medical studies. It was carried out on a low fidelity upper airway management dummy. We did not include learners who had previously practiced intubation. After randomization, 18 learners started learning by procedural simulation with video-laryngoscopy (type Medcaptain®) then direct laryngoscopy (type Macintosh) and 17 learners started with direct laryngoscopy then video-laryngoscopy. Then, all learners performed 3 intubation trials by using direct laryngoscopy and video-laryngoscopy according to the pre-established order. The primary endpoint was the time needed to intubate. Secondary endpoints were, Cormack classification, difficulties encountered and learners’ satisfaction.

Results

There was no significant difference in time needed to intubate between groups for the three attempts (p = 0.18, p = 0.45 and p = 0.1). The time needed to intubate by direct laryngoscopy was lower on the 1st and 3rd trials for learners who had started their training with video-laryngoscopy first (p = 0.02 and p = 0.01; respectively). There was no significant difference regarding the rate of successful intubation. The video-laryngoscopy allowed better visualization of vocal cords with more frequently noted Cormack I classification (p < 0.001, p = 0.002 and p < 0.001). The main difficulties encountered were the handling of the epiglottis and the tongue by the blade and the inserting the tracheal tube with no significant difference between the 2 techniques. Learners’ satisfaction was comparable.

Conclusion

Video-laryngoscopy improved vocal cord exposure during intubation on a manikin for novice learners.

Clinical trial registration

This study has been registered in Clinical Trials database NCT05859542.

Section snippetsBackground

Airway management is important in anesthesiology and critical care practice. Tracheal intubation is the cornerstone of airway management and is considered a high-risk procedure [1]. This technical skill requires a learning curve that differs depending on the used airway management device [2]. Direct laryngoscopy (DL) is the most used technique [3]. Indirect laryngoscopies were later developed to better manage airways in planned or unplanned difficult intubation. The visualization of the vocal

Methods

This was a randomized cross-over study, including 35 participants. It was conducted at the simulation center of the Faculty of Medicine of Tunis, Tunisia during 1 month starting from 1st June 2023. This study has been registered in Clinical Trials database NCT05859542.

Results

After checking the inclusion and exclusion criteria, 35 learners were included in this study. The flow chart is represented in Fig. 1. All the included learners were medical students at the Faculty of Medicine of Tunis. They were in the 5th year medical studies. Regarding the experience of the learners, 13 (37.1 %) had already attended at least one intubation by DL during their internships. No learner has performed an intubation before.

The time required for intubation was comparable between the

Discussion

The choice of the time required for intubation as the primary endpoint was justified by the fact that an increase in this time can raise the risk of hypoxia, aspiration, and cardiac arrest, especially in certain critical situations such as in a prehospital setting or induction in unfasted patients [1].

Eismann H et al., in a cross-over study, included 22 participants, mainly surgeons with little experience in intubation (14.8 ± 4 intubations per year) [7]. They compared a Macintosh laryngoscope

Conclusion

Intubation using video-laryngoscopy allowed better vocal cord exposure as per the Cormack and Lehane classification for novice learners in airway manikin. Conducting multicenter studies would be of significant interest to further assess it.

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

No grant support for the research reported.

CRediT authorship contribution statement

Faten Haddad: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Yasmine Trabelsi: Methodology, Investigation, Conceptualization. Alia Jebri: Visualization, Validation, Supervision, Project administration, Formal analysis. Abdelmajid Hafien: Supervision, Resources, Data curation, Conceptualization. Khalil Becheikh: Writing –

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (15)M.A. Malik et al.Comparison of the Glidescope®, the Pentax AWS®, and the Truview EVO2® with the Macintosh laryngoscope in experienced anaesthetists: a manikin study

Br. J. Anaesth.

(2009)

V. Russotto et al.Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries

JAMA

(2021)

G.L. Savoldelli et al.Learning curves of the Glidescope, the McGrath and the Airtraq laryngoscopes: a manikin study

Eur. J. Anaesthesiol.

(2009)

M.J. Silverberg et al.Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial

Crit. Care Med.

(2015)

J.L. Apfelbaum et al.American society of anesthesiologists practice guidelines for management of the difficult airway

Anesthesiology

(2022)

C.C. Kennedy et al.Advanced airway management simulation training in medical education: a systematic review and meta-analysis

Crit. Care Med.

(2014)

G.L. Savoldelli et al.Comparison of the Glidescope ® , the McGrath ® , the Airtraq ® and the Macintosh laryngoscopes in simulated difficult airways

Anaesthesia

(2008)

There are more references available in the full text version of this article.

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