Difficult Airway Simulation for Novice Physicians: A Randomized Trial Comparing Traditional and Video-Assisted Laryngoscopy

Abstract

Objectives:

Detect a difference in intubation success and total intubation times between novice physicians using either a Macintosh laryngoscope or a video-assisted laryngoscope (Glidescope®) on a difficult airway manikin simulator.

Methods:

This prospective randomized trial was performed in June 2012. 40 first year residents with less than five total live intubations were recruited. Training was provided by both faculty otolaryngologists and anesthesiologists using both laryngoscope types on a manikin airway simulator in a standard intubation scenario. This was followed by randomization to use one of the aforementioned laryngoscopes in a difficult intubation scenario. The difficult airway simulation entailed oral cavity/oropharyngeal obstruction using tongue inflation, with rigid cervical spine immobilization preventing extension and elevation of the head and limiting oral cavity opening. Success was defined as a confirmed endotracheal intubation by the instructor in 120 seconds or less.

Results:

The Macintosh laryngoscope group (n=19) had an intubation success rate of 52.63% with a mean intubation time of 69.0 (95% CI: 52.7, 85.2) seconds. The video-assisted group (n=21) demonstrated a significantly higher success rate of 100% (p<0.0001) and a decreased mean intubation time of 23.1 (95% CI: 18.4, 27.8) seconds (p<0.0001).

Conclusions:

Novice physicians with little to no prior intubation experience showed significantly higher intubation success with lower intubation times using a video assisted laryngoscope in a difficult airway manikin simulator.