Learning Intubation with Video-Assisted Optical Devices and with Direct Laryngoscopy - Differences in the Success of Intubation and Learning Curves
DOI:
https://doi.org/10.26332/azf0ej79Keywords:
laryngoscopy, intubation, intratracheal, learning curve, video assisted techniques and proceduresAbstract
Rapid laryngoscopy and intubation are essential for maintaining the airway in the management of patients with impaired consciousness, in patients during induction of anesthesia, and in intensive care units. By examining the patient in advance and using rating scales, it is possible to predict who will have difficulty with laryngoscopy and intubation. Special types of laryngoscopes are among the equipment necessary for difficult airway management. The choice of equipment contributes to successful intubations and fewer attempts. One of the most widely used devices is certainly the video laryngoscope, which comes in different variants. Studies on models in prehospital and hospital settings have shown that video laryngoscopy shortens the time to visualize the vocal cords and increases the success of intubation on the first attempt. The paper briefly describes the most commonly used devices for video-assisted intubation and presents results from studies comparing intubation success with different devices.
Keywords: laryngoscopy; intubation, intratracheal; learning curve; video assisted techniques and procedures
References
1. Hall JE. Guyton and Hall Physiology Review. Philadelphia (PA): Elsevier; 2020.
2. Jukić M, Husedžinović I, Kvolik S, Kogler VM, Perić M, Žunić J. Klinička anesteziologija. 2nd ed. Zagreb (HR): Medicinska naklada; 2013.
3. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega RA, et al. Clinical Anesthesia. 8th ed. Philadelphia (PA): Wolters Kluwer; 2017.
4. Trent SA, Driver BE, Prekker ME, Barnes CR, Brewer JM, Doerschug KC, et al. Defining successful intubation on the first attempt using both laryngoscope and endotracheal tube insertions: a secondary analysis of clinical trial data. Ann Emerg Med. 2023;82(4):432 437. doi:10.1016/j.annemergmed.2023.03.021
5. Butterworth JF 4th, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. New York (NY): McGraw Hill; 2013.
6. Marino PL. The ICU Book. 4th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2013.
7. Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110(4):891 897. doi:10.1097/ALN.0b013e31819b5b87
8. Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92(5):1229 1236. doi:10.1097/00000542 200005000 00009
9. Maldonado NG, Thompson M, Srihari C, Holtzman L, Liu J, Otero R, et al. Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: descriptive analysis of a 5 year experience at an academic teaching hospital. J Am Coll Emerg Physicians Open. 2024;5(3):e13175. doi:10.1002/emp2.13175
10. Kaplan MB, Hagberg CA, Ward DS, Brambrink A, Chhibber AK, Heidegger T, et al. Comparison of direct and video assisted views of the larynx during routine intubation. J Clin Anesth. 2006;18(5):357 362.
11. Yahagi M, Omi K, Yaguchi Y. A comparison of McGrath MAC, Airway Scope®, and AceScope® video laryngoscopes in novice healthcare providers: a randomized crossover simulation study. BMC Anesthesiol. 2025;25(1):212. doi:10.1186/s12871 025 03094 y
12. Turkstra TP, Pelz DM, Shaikh AA, Craen RA. Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet vs Macintosh laryngoscope. Can J Anaesth. 2007;54(6):441 447.
13. Kok T, George RB, McKeen D, Vakharia N, Pink A. Effectiveness and safety of the Levitan FPS Scope™ for tracheal intubation under general anesthesia with a simulated difficult airway. Can J Anaesth. 2012;59(8):743 750. doi:10.1007/s12630 012 9726 4
14. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with the GlideScope videolaryngoscope in 728 patients. Can J Anaesth. 2005;52(2):191 198.
15. Moon YJ, Kim J, Seo DW, Kim JW, Jung HW, Suk EH, et al. Endotracheal intubation by inexperienced trainees using the Clarus Video System: learning curve and orodental trauma perspectives. J Dent Anesth Pain Med. 2015;15(4):207 212. doi:10.17245/jdapm.2015.15.4.207
16. Lin YC, Cho AH, Lin JR, Chung YT. The Clarus Video System (Trachway) and direct laryngoscope for endotracheal intubation with cricoid pressure in simulated rapid sequence induction intubation: a prospective randomized controlled trial. BMC Anesthesiol. 2019;19(1):33. doi:10.1186/s12871 019 0703 0
17. Wylie NW, Phillips EC, Harrington JK, McNarry AF. Videolaryngoscopy utilization: facts and opinions. Trends Anaesth Crit Care. 2019;29:21 25.
18. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anesthesia. Br J Anaesth. 2011;106(5):617 631. doi:10.1093/bja/aer058
19. Prekker ME, Trent SA, Lofrano A, Russell DW, Barnes CR, Brewer JM, et al. Laryngoscopy and tracheal intubation: does use of a video laryngoscope facilitate both steps of the procedure? Ann Emerg Med. 2023;82(4):425 431. doi:10.1016/j.annemergmed.2023.02.016
20. Aziz MF, Abrons RO, Cattano D, Bayman EO, Swanson DE, Hagberg CA, et al. First attempt intubation success of video laryngoscopy in patients with anticipated difficult direct laryngoscopy: a multicenter randomized controlled trial comparing C MAC D Blade versus GlideScope in a mixed provider and diverse patient population. Anesth Analg. 2016;122(3):740 750. doi:10.1213/ANE.0000000000001084
21. Aziz MF, Bayman EO, Van Tienderen MM, Todd MM, Brambrink AM. Predictors of difficult videolaryngoscopy with GlideScope® or C MAC® with D blade: secondary analysis from a large comparative videolaryngoscopy trial. Br J Anaesth. 2016;117(1):118 123. doi:10.1093/bja/aew128
22. Shippey B, Ray D, McKeown D. Case series: the McGrath videolaryngoscope—an initial clinical evaluation. Can J Anaesth. 2007;54(4):307 313.
23. Hindman BJ, Santoni BG, Puttlitz CM, From RP, Todd MM. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes. Anesthesiology. 2014;121(2):260 271. doi:10.1097/ALN.0000000000000263
24. Frass M, Robak O, Truszewski Z, Czyzewski L, Szarpak L. Comparison of endotracheal intubation with the Airtraq Avant® and the Macintosh laryngoscope during intermittent or continuous chest compression: a randomized, crossover study in manikins. Disaster Emerg Med J. 2016;1(1):7 13.
25. Malik MA, Subramaniam R, Maharaj CH, Harte BH, Laffey JG. Randomized controlled trial of the Pentax AWS, GlideScope, and Macintosh laryngoscopes in predicted difficult intubation. Br J Anaesth. 2009;103(5):761 768. doi:10.1093/bja/aep266
26. Zhu H, Liu J, Suo L, Zhou C, Sun Y, Jiang H. A randomized controlled comparison of non channeled King Vision, McGrath MAC video laryngoscope and Macintosh direct laryngoscope for nasotracheal intubation in patients with predicted difficult intubations. BMC Anesthesiol. 2019;19(1):166. doi:10.1186/s12871 019 0838 z
27. Gunning SGS, Urwin D, Cook TM, Hansel J. Videolaryngoscopy versus direct laryngoscopy for teaching direct laryngoscopy skills: a systematic review and meta analysis. Br J Anaesth. 2025;135(5):1397 1409. doi:10.1016/j.bja.2025.05.034
28. Hannah J, Adetoro O, Watson AJR, Owen P, Gamblin J, Lloyd M, et al. Video laryngoscopy versus direct laryngoscopy in a UK pre hospital physician/critical care paramedic helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2025;33(1):120. doi:10.1186/s13049 025 01433
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