Comparison of the GlideScope Videolaryngoscope to the standard Macintosh for intubation by pediatric residents in simulated child airway scenarios.

OBJECTIVES

Videolaryngoscopy may facilitate tracheal intubation in difficult airway scenarios. Our objective was to compare the ability of residents to intubate a child manikin using the standard Macintosh laryngoscope and the novel GlideScope.

METHODS

Pediatric residents who passed an advanced pediatric life support course were eligible. Four scenarios were proposed: Macintosh (M) and GlideScope (G) "easy" intubation and M and G "difficult"; intubation (cervical immobilization with rigid collar). No participant had previous experience with videolaryngoscope. Each participant performed the 4 scenarios in a random sequence. Time from initiation of intubation procedure to inflation of manikin's chest was recorded, as well as the number of intubation attempts, number of additional maneuvers, dental injury index, and participant's subjective impression.

RESULTS

Eighteen subjects were included. Median (range) time for easy airway intubation was 18 seconds (8-120 seconds) with M versus 37 seconds (18-96 seconds) with G (P = 0.029). Time for intubation with cervical immobilization was 19 seconds (9-120 seconds) with M versus 49 seconds (22-120 seconds) with G (P = 0.006). The G intubation in case of cervical immobilization needed significantly more maneuvers than with the M intubation (P = 0.014). There were no significant differences when number of attempts, dental injury index, and participant's subjective difficulty rate were compared.

CONCLUSIONS

Without specific training, videolaryngoscope-guided intubation did not improve intubation performance by pediatric residents in this manikin model of normal and simulated difficult intubation caused by a cervical collar in place. To achieve skills with videolaryngoscope intubation in children, a specific training program is needed.