Comparison of Airtraq® and Macintosh laryngoscope applied by nurses in manikins with normal and difficult airways: pilot data

Introduction. Endotracheal intubation is currently the gold standard of airway management. In direct laryngoscopy in pre-hospital settings, though, it turns out insufficiently effective. Aim. The study purpose was to compare direct laryngoscopy and videolaryngoscopy for endotracheal intubation performed by nurses in normal and difficult airway conditions. Material and methods. This randomized cross-over study involved 27 nurses. The protocol was approved by the Institutional Review Board of the Polish Society of Disaster Medicine (approval number: 32.04.2018.IRB). The participants performed intubation using a Macintosh laryngoscope (MAC) and an Airtraq® videolaryngoscope (ATQ) in 2 study scenarios: A – normal airway; B – difficult airway. For this latter purpose, the manikin had the cervical spine immobilized with a standard one-piece cervical collar. Results. The effectiveness of the first intubation attempt with MAC and ATQ was varied both in scenario A: 66.7 and 92.6% (p = 0.007) and in scenario B: 14.8 and 70.4% (p = 0.001). The median intubation time in scenario A was 23 s (IQR: 22-33.5) for MAC and 17 s (IQR: 15.5-25) for ATQ (p = 0.031), respectively. In scenario B, this parameter value equaled 53 s (IQR: 48-67) for MAC and 26 s (IQR: 24-49) for ATQ (p < 0.001). Conclusions. In the simulation study, nurses were able to perform endotracheal intubation with the use of ATQ with higher efficacy compared with direct laryngoscopy – this relationship was observed under both normal and difficult airway conditions.