CoChat
Sign Up
Cited by 216Airway Management and Intubation TechniquesAnesthesia and Sedative AgentsTracheal and airway disorders

Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial

Open access
Kleine-Brueggeney, M, Greif, R, Schoettker, P, Savoldelli, G.L., Nabecker, S, Theiler, L.G.·2016·British Journal of Anaesthesia
DOI 10.1093/bja/aew058
Open this paper in CoChat — free accountOpen PDF

Abstract

Background Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway. Methods With ethics committee approval and written informed consent, 12 senior anaesthetists intubated the trachea of 720 patients. A cervical collar limited mouth opening and neck movement, making intubation difficult. We evaluated three unchannelled (C-MAC™ D-blade, GlideScope™, and McGrath™) and three channelled videolaryngoscopes (Airtraq™, A.P. Advance™ difficult airway blade, and KingVision™). The primary outcome was first-attempt intubation success rate. Secondary outcomes included overall success rate, laryngeal view, intubation times, and side-effects. The primary hypothesis for every videolaryngoscope was that the 95% confidence interval of first-attempt success rate is ≥90%. Results Mouth opening was decreased from 46 (sd 7) to 23 (3) mm with the cervical collar. First-attempt success rates were 98% (McGrath™), 95% (C-MAC™ D-blade), 87% (KingVision™), 85% (GlideScope™ and Airtraq™), and 37% (A.P. Advance™, P<0.01). The 95% confidence interval of first-attempt success rate was >90% only for the McGrath™. Overall success, laryngeal view, and intubation times differed significantly between videolaryngoscopes (all P<0.01). Side-effects were minor. Conclusions This trial revealed differences in the performance of six videolaryngoscopes in 720 patients with restricted neck movement and limited mouth opening. In this setting, first-attempt success rates were 85-98%, except for the A.P. Advance™ difficult airway blade. Highest success and lowest tissue trauma rates were achieved by the McGrath™ and C-MAC™ D-blade, highlighting the importance of the videolaryngoscope blade design. Clinical trial registration ClinicalTrials.gov: identifier NCT01692535.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/bja/aew058

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Literature comparing intubation devices in c-spine immobilized patients has yielded inconsistent findings, and no consensus as to the optimal approach.

    “Literature comparing intubation devices in c-spine immobilized patients has yielded inconsistent findings, and no consensus as to the optimal approach.38,44,45,48,49”

    From Airway Management in Trauma (2018) · cites this paper as [48]

    The Discussion (page unavailable) says the optimal videolaryngoscope may differ with the circumstances of the difficult airway, supporting the absence of one universally optimal device. But it also says prior studies agree that videolaryngoscopes have higher success rates than the Macintosh laryngoscope, so it does not support a blanket characterization of the findings as inconsistent. This trial used simulated cervical-spine immobilization with reduced mouth opening, rather than studying all immobilized patients. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 43

  1. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106: 617-31
  2. Pandit JJ, Popat MT, Cook TM, et al. The Difficult Airway Soci- ety 'ADEPT' guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia 2011; 66: 726-37 Six videolaryngoscopes in 720 difficult airways | 677
  3. Cook T, Pandit J, Wilkes A. Introduction and evaluation of new airway devices: current issues. TACC 2012; 2: 264-8
  4. Cook TM. Novel airway devices: spoilt for choice? Anaesthesia 2003; 58: 107-10
  5. Marshall EM, O'Loughlin E, Swann AD. First comparison of the Venner™ A.P. Advance™ versus the Macintosh laryngo- scope for intubations by non-anaesthetists: a manikin study. Emerg Med Australas 2014; 26: 262-7
  6. Langley A, Mar Fan G. Comparison of the Glidescope ® , flexible fibreoptic intubating bronchoscope, iPhone modified bron- choscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study. BMC Anesthesiol 2014; 14: 10
  7. Murphy LD, Kovacs GJ, Reardon PM, Law JA. Comparison of the King Vision video laryngoscope with the Macintosh la- ryngoscope. J Emerg Med 2014; 47: 239-46
  8. Wetsch WA, Spelten O, Hellmich M, et al. Comparison of dif- ferent video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, con- trolled crossover trial. Resuscitation 2012; 83: 740-5
  9. Byhahn C, Iber T, Zacharowski K, et al. Tracheal intubation using the mobile C-MAC video laryngoscope or direct laryn- goscopy for patients with a simulated difficult airway. Minerva Anestesiol 2010; 76: 577-83
  10. Jungbauer A, Schumann M, Brunkhorst V, Borgers A, Groeben H. Expected difficult tracheal intubation: a prospect- ive comparison of direct laryngoscopy and video laryngos- copy in 200 patients. Br J Anaesth 2009; 102: 546-50
  11. Asai T, Liu EH, Matsumoto S, et al. Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology 2009; 110: 898-904
  12. Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effect- iveness of the C-MAC video laryngoscope versus direct laryn- goscopy in the setting of the predicted difficult airway. Anesthesiology 2012; 116: 629-36
  13. Enomoto Y, Asai T, Arai T, Kamishima K, Okuda Y. Pentax- AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study. Br J Anaesth 2008; 100: 544-8
  14. Serocki G, Neumann T, Scharf E, Dorges V, Cavus E. Indir- ect videolaryngoscopy with C-MAC D-Blade and Glide- Scope: a randomized, controlled comparison in patients with suspected difficult airways. Minerva Anestesiol 2013; 79: 121-9
  15. McElwain J, Laffey JG. Comparison of the C-MAC ® , Airtraq ® , and Macintosh laryngoscopes in patients undergoing tracheal in- tubation with cervical spine immobilization. Br J Anaesth 2011; 107: 258-64
  16. Cavus E, Neumann T, Doerges V, et al. First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation. Anesth Analg 2011; 112: 382-5
  17. Taylor AM, Peck M, Launcelott S, et al. The McGrath ® Series 5 videolaryngoscope vs the Macintosh laryngoscope: a rando- mised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013; 68: 142-7
  18. Sakles JC, Mosier JM, Patanwala AE, Dicken JM, Kalin L, Javedani PP. The C-MAC ® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. J Emerg Med 2015; 48: 280-6
  19. Aziz MF, Abrons RO, Cattano D, et al. First-attempt intubation success of video laryngoscopy in patients with anticipated difficult direct laryngoscopy: a multicenter randomized controlled trial comparing the C-MAC D-Blade versus the GlideScope in a mixed provider and diverse patient popula- tion. Anesth Analg 2016; 122: 740-50
  20. Ng I, Hill AL, Williams DL, Lee K, Segal R. Randomized con- trolled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways. Br J Anaesth 2012; 109: 439-43
  21. Rosenstock C, Gillesberg I, Gatke MR, Levin D, Kristensen MS, Rasmussen LS. Inter-observer agreement of tests used for prediction of difficult laryngoscopy/tracheal intubation. Acta Anaesthesiol Scand 2005; 49: 1057-62
  22. Karkouti K, Rose DK, Ferris LE, Wigglesworth DF, Meisami- Fard T, Lee H. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth 1996; 43: 554-9
  23. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005; 103: 429-37
  24. Liu EH, Goy RW, Tan BH, Asai T. Tracheal intubation with vi- deolaryngoscopes in patients with cervical spine immobil- ization: a randomized trial of the Airway Scope and the GlideScope. Br J Anaesth 2009; 103: 446-51
  25. Byhahn C, Nemetz S, Breitkreutz R, Zwissler B, Kaufmann M, Meininger D. Brief report: tracheal intubation using the Bon- fils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway. Can J Anaesth 2008; 55: 232-7
  26. Theiler LG, Kleine-Brueggeney M, Kaiser D, et al. Crossover comparison of the Laryngeal Mask Supreme™ and the i-gel™ in simulated difficult airway scenario in anesthetized patients. Anesthesiology 2009; 111: 55-62
  27. Bathory I, Frascarolo P, Kern C, Schoettker P. Evaluation of the GlideScope for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar. Anaesthesia 2009; 64: 1337-41
  28. Theiler L, Hermann K, Schoettker P, et al. SWIVIT -Swiss video-intubation trial evaluating video-laryngoscopes in a simulated difficult airway scenario: study protocol for a mul- ticenter prospective randomized controlled trial in Switzer- land. Trials 2013; 14: 94
  29. Levitan RM, Ochroch EA, Kush S, Shofer FS, Hollander JE. As- sessment of airway visualization: validation of the percent- age of glottic opening (POGO) scale. Acad Emerg Med 1998; 5: 919-23
  30. Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score character- izing the complexity of endotracheal intubation. Anesthesiology 1997; 87: 1290-7
  31. Kleine-Brueggeney M, Nicolet A, Nabecker S, et al. Blind intub- ation of anaesthetised children with supraglottic airway de- vices AmbuAura-i and Air-Q cannot be recommended: a randomised controlled trial. Eur J Anaesthesiol 2015; 32: 631-9
  32. Butchart AG, Tjen C, Garg A, Young P. Paramedic laryngos- copy in the simulated difficult airway: comparison of the Venner A.P. Advance and GlideScope Ranger video laryngo- scopes. Acad Emerg Med 2011; 18: 692-8
  33. Burdett E, Ross-Anderson DJ, Makepeace J, Bassett PA, Clarke SG, Mitchell V. Randomized controlled trial of the A. P. Advance, McGrath, and Macintosh laryngoscopes in nor- mal and difficult intubation scenarios: a manikin study. Br J Anaesth 2011; 107: 983-8
  34. Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology 2011; 114: 34-41
  35. Maharaj CH, Buckley E, Harte BH, Laffey JG. Endotracheal in- tubation in patients with cervical spine immobilization: a comparison of Macintosh and Airtraq laryngoscopes. Anesthesiology 2007; 107: 53-9
  36. Suppan L, Tramer MR, Niquille M, Grosgurin O, Marti C. Alter- native intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic re- view and meta-analysis of randomized controlled trials. Br J Anaesth 2016; 116: 27-36
  37. De Jong A, Molinari N, Conseil M, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med 2014; 40: 629-39
  38. Hossfeld B, Frey K, Doerges V, Lampl L, Helm M. Improvement in glottic visualisation by using the C-MAC PM video laryngo- scope as a first-line device for out-of-hospital emergency tra- cheal intubation: an observational study. Eur J Anaesthesiol 2015; 32: 425-31
  39. Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical appli- cations. Br J Anaesth 2010; 105: 683-90
  40. Savoldelli GL, Schiffer E, Abegg C, Baeriswyl V, Clergue F, Waeber JL. Comparison of the Glidescope, the McGrath, the Airtraq and the Macintosh laryngoscopes in simulated diffi- cult airways. Anaesthesia 2008; 63: 1358-64
  41. Jeon WJ, Shim JH, Cho SY, Baek SJ. Stylet-or forceps-guided tube exchanger to facilitate GlideScope ® intubation in simu- lated difficult intubations -a randomised controlled trial. Anaesthesia 2013; 68: 585-90
  42. Ali QE, Das B, Amir SH, Siddiqui OA, Jamil S. Comparison of the Airtraq and McCoy laryngoscopes using a rigid neck collar in patients with simulated difficult laryngoscopy. J Clin Anesth 2014; 26: 199-203
  43. Konrad C, Schupfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesth Analg 1998; 86: 635-9 Handling editor: T. Asai

Cited by

Sorted by citations

Authors
Kleine-Brueggeney, M., Greif, R., Schoettker, P., Savoldelli, G. L., Nabecker, S., & Theiler, L. G.
Affiliations
  • University of Bern (CH)
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of Geneva (CH)
ORCID
Venue
British Journal of Anaesthesia
Publisher
Elsevier BV
Published
2016-05
Volume
116
Issue
5
Pages
670-679
ISSN
0007-0912 (ISSN-L)
DOI
10.1093/bja/aew058
OpenAlex
W2339980682
Cited by
216
References
0
Citations by year
2026: 15 · 2025: 15 · 2024: 21 · 2023: 26 · 2022: 21 · 2021: 27 · 2020: 18 · 2019: 19 · 2018: 14 · 2017: 30 · 2016: 10
FWCI
30.93
Type
journal article
Language
en
Update notices
erratum (2016-09-01)
Open access
Licence
Locations
  • British Journal of Anaesthesia (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion)
  • BORIS (University Library Bern) (submittedVersion, other-oa)
  • IRIS (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
  • Open Access CRIS of the University of Bern
Funders
  • Gottfried and Julia Bangerter-Rhyner Foundation, Basel, Switzerland
  • Fondation Latine des Voies Aériennes (FLAVA), Lausanne, Switzerland
  • Swiss Society of Anaesthesiology and Resuscitation
  • Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, Bern, Switzerland
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
Keywords
video laryngoscope, difficult airway, endotracheal intubation, first-attempt intubation success, McGrath videolaryngoscope, GlideScope, Airtraq, limited mouth opening, laryngeal view, intubation time, tissue trauma
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anesthesia, General, Double-Blind Method, Equipment Design, Female, Humans, Intubation, Intratracheal, Laryngoscopy, Male, Middle Aged, Prospective Studies, Video Recording, Laryngoscopes, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review