Comparison of glidescope video laryngoscopy and conventional laryngoscopy for endotracheal intubation in the ED : an observational study

Abstract

Objectives In a previous manikin study, we suggested that the GlideScope® Video Laryngoscope (GVL) could be an option for airway management by emergency physicians and might be useful in patients with difficult airways compared to the classic Macintosh laryngoscope (ML). The purpose of this study was to compare GVL with ML in emergency endotracheal intubation.Materials and methodsA prospective multicenter observational study was performed. Emergency physicians performed tracheal intubations using ML or GVL at their discretion. The time required to intubate, the success rate, number of intubation attempts, Cormack and Lehane (C&L) grade, and percentage of glottis opening (POGO) scores were recorded and compared between the two groups.ResultsGVL was used in 27 (37.5%) of 72 endotracheal intubations at three emergency centers. The overall success rate in the GVL group on the first attempt was not higher than that in the ML group (66.7% vs 60.0%, P=0.572). Although the success rate for difficult airway patients on the first attempt seemed to be higher in the GVL group than in the ML group, there was not a statistically significant difference between the two groups (70% vs 46.7%, p=0.250). The overall time required to successfully intubate was shorter in the ML group than in the GVL group (18.3 sec vs. 36.8 sec, p<0.05). In the difficult airway subgroup, the time required to successfully intubate was shorter in the ML group (15.9 sec vs. 36.3 sec, p<0.05). The POGO score and the C&L grade were not statistically different between the two groups although the GVL group appeared to allow a better glottic view in the difficult airway subgroup (POGO: 39.3 ± 36.9 vs. 55.5 ± 32.7, p = 0.394; GEG I & II: 55.3% vs. 70%, p=0.405).ConclusionThe emergency airway management using GVL did not show difference in success rate compared with ML. However, the required time for intubation was longer in GVL than ML. This study suggests that GVL is not as suitable for emergency airway management as ML, even in patients with difficult airways.