gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

25.10. - 28.10.2016, Berlin

Comparison of direct laryngoscopy and video-assisted-laryngoscopy in simulated normal and difficult prehospital Helicopter Medical Service airway scenarios

Meeting Abstract

  • presenting/speaker Christian Zeckey - Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
  • Lion Sieg - Klinik für Anästhesiologie und Intensivmedizin, Hannover, Germany
  • Nicola Etti - Klinik für Anästhesiologie und Intensivmedizin, Hannover, Germany
  • Christian Schröter - Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
  • Christian Krettek - Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
  • Hendrik Eismann - Klinik für Anästhesiologie und Intensivmedizin, Hannover, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocWI36-1245

doi: 10.3205/16dkou230, urn:nbn:de:0183-16dkou2304

Veröffentlicht: 10. Oktober 2016

© 2016 Zeckey et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives: Skilled interventions in airway management are often crucial in prehospital management of critically ill patients. We aimed to evaluate if there might be more success in securing an airway if the moderately trained provider in the prehospital environment uses a videolaryngoscope in every first attempt of an emergency intubation. We hypothesized that with a videolaryngoscopic device the intubation success rate of a moderately provider is higher and the process is faster compared to a conventional laryngoscopy. In addition, we tried to elucidate differences between commonly used video laryngoscopy devices.

Methods: All participants took part in a standardized workshop with a lecture about the differences between direct and videolaryngoscopy followed by a hands-on workshop to familiarize our participants with the airway devices we used in our study. For conventional standard laryngoscopy or direct laryngoscopy (DL) we used a Macintosh laryngoscope. For videolaryngoscopy (VL) we used three different devices, which are common in Germany: cMac size 4 with portable monitor, dBlade with portable monitor and a KingVision videolaryngoscope with attached tube channel. Each participant in the study had to perform an endotracheal intubation in each of the three simulated airways with every devices available in the study (12 intubations per participant in total). Time from when entering the manikin's airway to when the glottic opening became visible (time to view) to when the trachea was intubated (time to intubation) was evaluated. We investigated the Cormack and Lehane classification and the percentage of glottic opening (POGO) score, the intubation was aborted after a maximum period of 60 seconds. After every intubation the participants were asked to review the airway device.

Results and Conclusion: We evaluated the intubation attempts of 22 participants. Our participants perform 14,8±18,2 intubations per year. The mean total number of DL intubations was 148,8±331,9 and of videolaryngoscopy it was 0,4±0,7. We found improved C+L grades with videolaryngoscopy in contrast to direct laryngoscopy. We saw similar data with respect to the POGO score, where the participants achieved better visibility of the glottis with VL. The hyperangulated blade geometries provided a better visibility than the standard geometry of the Macintosh-type blades.

The subjective performance of the VL devices was better in more difficult airway scenarios. For a normal airway the participants rated all devices as almost equal. In our most difficult airway the Macintosh laryngoscope performed the worst, whereas the VL devices were rated better.

After a short introduction and limited hands-on training a videolaryngoscope seems to be safe and usable by moderately trained providers. We assume a standard geometry laryngoscope is optimal for a patient with normal anatomy and a VL device with a hyperangulated blade is ideal for difficult airway situations with limited mouth opening or restricted neck movement.