Comparison of the McGrath ® MAC video laryngoscope with direct Macintosh laryngoscopy for novice laryngoscopists in children without difficult intubation: A randomised controlled trial.

INTRODUCTION: Airway management and tracheal intubation are routinely performed in paediatric anaesthesia and yet are associated with preventable adverse events. The McGrath® MAC is a video laryngoscope with a curved blade similar to the Macintosh blade, which has not been previously described in first intention paediatric tracheal intubation. We aimed to compare direct laryngoscopy to the McGrath® MAC video laryngoscope among novice laryngoscopists.

METHODS: Six paediatric anaesthesia residents with novice skills in paediatric laryngoscopy were randomly assigned to perform tracheal intubation using either direct Macintosh laryngoscopy (DL) or the McGrath® MAC video laryngoscope (MM) as the first attempted device in children weighing between 10 and 20kg without difficult intubation.

RESULTS: Our study enrolled 132 children between August 2013 and April 2015. The time to intubation was shorter in the DL group (n=67) compared to the MM group (n=65) with 42s (35-50) versus 48s (43-58) P=0.002. The time to best view was similar between the two groups (10s [7-16] versus 10s [8-15]; P=0.50). The tube passage time was shorter with DL (29s [25-35] versus 35s [30-45]; P=0.0002) and either Cormak & Lehane grade or Percentage Of Glottis Opening (POGO) scores were similar between groups. Minor reversible respiratory adverse events were similar between groups: 12 in the DL group (17.9%) versus 12 in the MM group (18.5%).

DISCUSSION: McGrath® MAC video laryngoscopy, when performed by a novice laryngoscopist on easy-to-intubate children, is associated with longer intubation times.