Tracheal intubation during chest compressions using Pentax-AWS(®), GlideScope (®), and Macintosh laryngoscope: a randomized crossover trial using a mannequin.

BACKGROUND: A randomized crossover trial was conducted to compare the performance of two videolaryngoscopes (Pentax-AWS(®), GlideScope(®)) with the Macintosh laryngoscope for tracheal intubation during continuous chest compressions on a mannequin.

METHODS: Thirty-two inexperienced junior interns performed tracheal intubations on an advanced life support simulator with either a normal or difficult airway scenario. The sequence of intubating devices and airway difficulty were randomized. The following data were measured and recorded: time to complete tracheal intubation (primary end point), overall success rate, time to visualize the vocal cords, percentage of glottic opening, dental compression, and ease of intubation.

RESULTS: With a normal airway, the times (median [interquartile range]) to complete tracheal intubation were shorter with the Pentax-AWS (12.1 [10.1-14.4] sec) and the GlideScope (14.3 [12.4-17.6] sec) than with the Macintosh laryngoscope (16.5 [13.1-22.1] sec) (P < 0.03 for both). The time difference between the two videolaryngoscopes was not statistically significant. With a difficult airway scenario, the times to complete tracheal intubation were 13.9 [10.9-20.4] sec, 19.2 [16.4-32.3] sec, and 30.1 [21.0-56.5] sec, respectively (P < 0.05 for all differences). The videolaryngoscopes were also more effective than the Macintosh laryngoscope with respect to secondary outcomes.

CONCLUSIONS: The two videolaryngoscopes were superior to the Macintosh laryngoscope in terms of performing tracheal intubation during continuous chest compressions on a mannequin. In a difficult airway scenario simulating cardiac arrest, the Pentax-AWS performed better than the GlideScope.