Comparison of the McGrath MAC EMS Videolaryngoscope with a Conventional Laryngoscope for Standard and Difficult Airway Intubation: A Randomized, Cross-over, Simulation Trial

Abstract

Aim: Tracheal intubation is challenging in emergency medicine, especially in pre-hospital settings, owing to problems connected withpatients, intubator, and the environment. The study aimed to compare the effectiveness of endotracheal intubation performed byparamedics with the use of direct laryngoscopy and the McGrath MAC videolaryngoscope in standard and difficult airway settings.Materials and Methods: The study was designed as a prospective, randomized, cross-over simulation study. It involved 52 paramedics.The participants performed endotracheal intubation in two scenarios: Normal airway and difficult airway, achieved by inflation of thesimulator tongue to the level of difficulty determined by an independent instructor at grade 3 on the Cormack-Lehane scale. The primaryendpoint was the success of endotracheal intubation; intubation time constituted the secondary endpoint.Results: The median age of participants was 24 years [interquartile range (IQR): 23-25], and the median work experience was 0.5 years (IQR:0-1). In normal airway (scenario A), the effectiveness of the first intubation attempt was 92.3% for MAC and 96.2% for McGrath (p=0.724).The median intubation time for MAC was 19 (IQR: 14-21.5) seconds and was statistically significantly longer than 16 (12.5-20) seconds forMcGrath (p=0.047). The ease of intubation was 18 (IQR: 10-20) points for McGrath and 25 (IQR: 16-27) points for MAC (p=0.035). In difficultairway (scenario B), the efficacy of the first intubation attempt for MAC and McGrath equaled 40.4% and 82.7%, respectively. The medianintubation time for McGrath was 19 (IQR: 14-27.5) seconds and was significantly shorter than 25 (IQR: 24-39) seconds for MAC (p=0.007). Thedegree of glottis visualization was statistically significantly better in McGrath than in MAC (p