Initial Laryngoscope Blade Selection and Outcomes in Paediatric Emergency Department Intubations: Miller vs. Macintosh

IF 1.5 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia Pub Date : 2026-07-12 DOI:10.1111/1742-6723.70306

Andrew Wallace, Hatem Alkhouri, Helen Badge, Toby Fogg, Elliot Long

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引用次数: 0

Abstract

Background

Optimal initial laryngoscope blade selection for paediatric emergency intubation is uncertain. We examined whether Miller or Macintosh blades are associated with differences in first-pass success (FPS) and adverse events in children < 5 years.

Methods

Prospectively collected data from the Australia and New Zealand ED Airway Registry (ANZEDAR) between March 2010 and March 2024 were analysed for children under 5 years of age. We report demographics, FPS and adverse events by initial blade type. Multivariable models examined factors associated with FPS and hypoxia.

Results

Among 201 children, 88 (43.8%) were intubated with a Miller blade and 113 (56.2%) with a Macintosh blade. In unadjusted analyses, children intubated with Miller blades were younger (median 0.4 years, IQR 0.08–1.35 vs. median 1.6 years, IQR 0.75–2.00), p < 0.001), had lower FPS (63.6% vs. 80.5%; OR 0.42, 95% CI 0.22–0.80; p = 0.008) and had a higher incidence of hypoxia (33.0% vs. 17.7%; OR 2.28, 95% CI 1.19–4.46; p = 0.01) compared with children intubated with Macintosh blades. Hypotension rates did not differ.

Conclusion

In this cohort of young children intubated in the ED, Macintosh blade use was associated with higher FPS and fewer hypoxic events compared with Miller blade. Age was a significant confounder and should be considered when choosing which laryngoscope blade to use in young children.

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儿科急诊科插管的初始喉镜刀片选择和结果：Miller vs. Macintosh。

背景：小儿急诊插管喉镜刀片的最佳初始选择是不确定的。我们研究了Miller刀片或Macintosh刀片是否与儿童首次通过成功率（FPS）和不良事件的差异有关。方法：前瞻性收集2010年3月至2024年3月期间澳大利亚和新西兰ED气道登记处（ANZEDAR）的数据，对5岁以下儿童进行分析。我们报告人口统计，FPS和不良事件的初始叶片类型。多变量模型检验了与FPS和缺氧相关的因素。结果：201例患儿中，88例（43.8%）采用Miller刀片插管，113例（56.2%）采用Macintosh刀片插管。在未经调整的分析中，插管Miller刀片的儿童年龄更小（中位年龄0.4岁，IQR为0.08-1.35，中位年龄1.6岁，IQR为0.75-2.00），p结论：在这个插管ED的幼儿队列中，与Miller刀片相比，Macintosh刀片的使用与更高的FPS和更少的缺氧事件相关。年龄是一个重要的混杂因素，在选择用于幼儿的喉镜刀片时应予以考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.