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. Methods: The study involved 55 4th year students of Faculty of Medicine and Dentistry who had never previously practiced using videolaryngoscopes and had minimal experience with the Macintosh laryngoscope. 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 s, IQR: 8.4-12.25) compared to Macintosh (27 s, IQR: 23.8-32.05), I-View (24.5 s, IQR: 19.25-31.35), and UESCOPE (23.6 s, 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 %) Conclusions: Airtraq laryngoscope on a mannequin model turned out to be device that damages the teeth the least, exerts the lowest pressure on the tongue and giving the possibility of the fastest intubation with the greatest comfort for the operator in the studied group of users.