Tracheal intubation in the ice-pick position with video laryngoscopes A randomised controlled trial in a manikin

CONTEXTTracheal intubation in nonstandardised positions is associated with a higher risk of tube misplacement and may have deleterious consequences for patients. Video laryngoscopes for tracheal intubation facilitate both glottic view and success rates. However, their use in the ice-pick position has not been evaluated.OBJECTIVETo evaluate the role of video laryngoscopes for tracheal intubation in the ice-pick position.DESIGNA randomised, controlled manikin trial.SETTINGA standardised airway manikin was placed in the corner of a room. Tracheal intubation was only possible from the lower right side of the manikin. In randomised order, participants used a standard Macintosh laryngoscope and GlideScope Ranger, Storz C-MAC, Pentax AWS, Airtraq and McGrath Series5 video laryngoscopes. Statistical analysis was performed using the Wilcoxon signed-rank and McNemar's tests; A P value of less than 0.05 was deemed statistically significant.PARTICIPANTSTwenty anaesthesiologists, all emergency medicine board-certified.MAIN OUTCOME MEASURESTime to first ventilation (primary); time to glottic view and confirmation of tube position (secondary).RESULTSSuccessful ventilation was achieved most rapidly with the Macintosh laryngoscope (36.113.4s; reference method), followed by the Airtraq (38.436.3s; P=n.s.), Pentax AWS (51.6 +/- 43.3s; P=n.s.) and Storz C-Mac (62.7 +/- 49.7s; P=n.s.). The use of the GlideScope Ranger (79.8 +/- 61.9s, P=0.01) and McGrath series5 (79.8 +/- 58.5s, P=0.023) resulted in significantly longer times. When comparing overall intubation success, the rate of successful tracheal intubation was higher with the Airtraq than with the McGrath Series5 (P=0.031; all others n.s.).CONCLUSIONThe use of video laryngoscopes did not result in higher success rates or faster tracheal intubation in the ice-pick position when compared with conventional laryngoscopy in this manikin study.TRIAL REGISTRATIONwww.clinicaltrials.gov, NCT01210105.