Objective: The purpose of this study was to compare insertion success rates and time to insertion of 4 video laryngoscope systems, standard endotracheal intubation (ETI), and the King LTS-D airway during a simulated complex airway scenario.
Methods: Following IRB approval, EMS providers were briefly trained on each of the following devices: 1) ETI, 2) King LTS-D, 3) Storz C-MAC, 4) Glidescope GVL, 5) McGrath Series 5, and 6) Prodol AirTraq. After a short practice session with each device, all providers attempted to successfully place each airway within 120 seconds. The order of device placement was randomized and set in advance. Simulated emesis (blended mixture of oatmeal, mixed vegetables, water, and beer) was introduced into the manikin’s airway during the first placement attempt with each device via concealed tubing and a pump. The manikin’s neck was also fixed to simulate a blunt trauma scenario. Suction and gum elastic bougie were available to all providers. Placement success was compared using logistic regression, and time to successful placement was compared using repeated measures ANOVA.
Results: Seventy EMS providers (17 EMT-B, 53 Paramedic) participated in the study. There were no differences in success rates for any device between EMT-Bs and paramedics (p = 0.55). Cumulative success rates for both EMT-B and paramedics with each device were as follows: ETI = 95.7%; King = 94.3%; C-MAC = 91.43%; Glidescope = 87.1%, McGrath = 48.8% and AirTraq = 48.6%. The AirTraq and McGrath success rates were significantly lower than ETI, King, Glidescope, and C-MAC success rates (p < 0.05 for each comparison). Average time to insertion (seconds) were: King = 25.7±18.1, ETI = 40.5±18.8; C-MAC = 43.3±18.7; Glidescope = 54.2±23.7; AirTraq = 60.5±22.9; McGrath = 65.2±29.7. The King LTS-D was placed significantly faster than all other devices (p < 0.001 for each comparison). ETI placement time was significantly faster than the Glidescope, AirTraq, and McGrath (p < 0.001 for each comparison).
Conclusion: In a difficult airway scenario, the AirTraq and McGrath had much lower success rates compared to the other devices. Time to successful placement was fastest with the King LTS-D.