Safety Assessment of Using Macintosh Laryngoscope, Airtraq, I-View, UESCOPE by Non-Clinically Experienced Individuals on a Manikin Model: A Randomized Cross-Over Study

Background

Endotracheal intubation is the best way of restoring airway patency. Covid-19 epidemic showed that the health professionals without previous experience may be forced to use this technique in the state of necessity, exposing the patients to both local and systemic complications. In our study we wanted to specify which of the four laryngoscopes is safer for a patient when used by this group of medical staff.

Results

Dental injury rates: Macintosh (n=18, 33%), I-View (n=13, 24%), UESCOPE (n=10, 18%), and Airtraq (n=7, 13%), though differences were not statistically significant (p=0.071). Notable variations were observed in maximum pressure: I-View (88.9 mmHg, IQR: 72.75-106.5), Macintosh (87.1 mmHg, IQR: 75.1-110.35), UESCOPE (72.7 mmHg, IQR: 61-86), and Airtraq (54.7 mmHg, IQR: 41.8-67.25). The difference between Macintosh and I-View was not significant. Pressure during intubation showed a similar trend: Macintosh (48.3 mmHg, IQR: 42.85-59.4), I-View (45.2 mmHg, IQR: 35.7-54.85), UESCOPE (33 mmHg, IQR: 27.95-41.5), Airtraq (21.6 mmHg, IQR: 18.4-24.9). Airtraq usage correlated with shorter intubation times (9.9 seconds, IQR: 8.4-12.25) compared to Macintosh (27 seconds, IQR: 23.8-32.05), I-View (24.5 seconds, IQR: 19.25-31.35), and UESCOPE (23.6 seconds, IQR: 17-29.5). Airtraq was the best-rated device by respondents. Airway visualization was superior with Airtraq, as assessed by Cormack-Lehane and POGO scales. On the Cormack-Lehane scale, Airtraq scored 2 (IQR: 2-2), versus Macintosh (3, IQR: 3-3), I-View (2, IQR: 2-3), and UESCOPE (2, IQR: 2-3) . On the POGO scale, Airtraq scored 70% (IQR: 60%-90%), compared to Macintosh (30%, IQR: 20%-30%), I-View (60%, IQR: 30%-60%), and UESCOPE (50%, IQR: 30%-70%)

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