Video laryngoscopy with the macintosh video laryngoscope in simulated prehospital scenarios by paramedic students.

OBJECTIVE: To investigate the effectiveness of the Karl Storz BERCI DCI Macintosh video laryngoscope (MVL) via the TELE PACK system for facilitating intubation by novice paramedic students in a simulation environment. We assessed the laryngeal view, measured by percentage of glottic opening (POGO), when intubating the SimMan manikin airway in different settings. The primary endpoint was the best POGO achieved by the student. Secondary endpoints included intubation times and success rate.

METHOD: We enrolled 25 novice paramedic students to intubate SimMan manikins. Students were randomized to use either a conventional Macintosh 3 (Mac3) blade alone or the MVL with a Mac3 blade. Students attempted their first intubation with the manikin on a stretcher in a normal neck position and reattempted intubation with the manikin's neck stiffened. The groups then crossed over using the alternate device to repeat the attempts in the manikin with a normal neck and with a stiffened neck. The students then attempted the same sequence of four intubations with the manikin on the floor.

RESULTS: The MVL significantly improved POGO in all scenarios (p < 0.05). The MVL improved mean POGO 16% +/- 6% in the manikin with a normal neck position on a stretcher and 33% +/- 7% in the manikin with a stiff neck on the floor. The improvement was significantly greater in simulated difficult scenarios. The intubation success rate (94%) was equal in the two groups, and the POGO was significantly worse in the failures. In some subgroups, intubation times were longer with the MVL.

CONCLUSION: The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting, and this improvement is greatest in simulated difficult scenarios.