Comparison of the McGrath® series 5 and GlideScope® Ranger with the Macintosh laryngoscope by paramedics

Background: Out-of-hospital endotracheal intubation performed by paramedics using the Macintosh blade for direct laryngoscopy is associated with a high incidence of complications. The novel technique of video laryngoscopy has been shown to improve glottic view and intubation success in the operating room. The aim of this study was to compare glottic view, time of intubation and success rate of the McGrath (R) Series 5 and GlideScope (R) Ranger video laryngoscopes with the Macintosh laryngoscope by paramedics. Methods: Thirty paramedics performed six intubations in a randomised order with all three laryngoscopes in an airway simulator with a normal airway. Subsequently, every participant performed one intubation attempt with each device in the same manikin with simulated cervical spine rigidity using a cervical collar. Glottic view, time until visualisation of the glottis and time until first ventilation were evaluated. Results: Time until first ventilation was equivalent after three intubations in the first scenario. In the scenario with decreased cervical motion, the time until first ventilation was longer using the McGrath (R) compared to the GlideScope (R) and AMacintosh (p < 0.01). The success rate for endotracheal intubation was similar for all three devices. Glottic view was only improved using the McGrath (R) device (p < 0.001) compared to using the Macintosh blade. Conclusions: The learning curve for video laryngoscopy in paramedics was steep in this study. However, these data do not support prehospital use of the McGrath (R) and GlideScope (R) devices by paramedics