Comparing intubation distances between direct and video laryngoscopes using motion capture: a mannequin study.

Abstract

Background: There is a risk of exposure to aerosols and secretions from the patient during tracheal intubation, particularly in patients with infectious disease or during cardiopulmonary resuscitation. We hypothesized that, compared with a direct laryngoscope, the use of a videolaryngoscope would reduce this risk by increasing the intubation distance between the upper airways of the patient and the intubator during tracheal intubation.

Methods: As a cross-over design, we continuously measured the intubation distance, using a motion capture system, between a direct laryngoscope and two videolaryngoscopes (McGrath MAC (McG) and Airway Scope (AWS)), during simulated tracheal intubation in an intubation mannequin. Ten anesthesiologists participated. In Situation 1, a mannequin was placed on a table to simulate in-hospital tracheal intubation. In Situation 2, it was placed on the floor to simulate out-of-hospital tracheal intubation. The primary outcome was the shortest intubation distance.

Results: All tracheal intubations were successful. In Situation 1, the shortest intubation distance was significantly shorter with the direct laryngoscope (20.8 cm) than with the McG (44.2 cm; P=0.007), or with the AWS (42.9 cm; P=0.005). In Situation 2, the shortest intubation distance was significantly shorter with the direct laryngoscope (18.8 cm) than with the McG (30.0 cm; P=0.007), or with the AWS (38.8 cm; P=0.013).

Conclusions: Using a videolaryngoscope would extend the intubation distance, in both in-hospital and out-of-hospital intubations, compared with a direct laryngoscope. Therefore, using a videolaryngoscope may reduce the risk of infection from patient to intubator.