Department of Prehospital Emergency Medicine, Greater Sydney Area HEMS, Sydney, Australia.
Eur J Anaesthesiol. 2013 Sep;30(9):544-9. doi: 10.1097/EJA.0b013e3283615b80.
Patients with multisystem trauma undergoing intubation with manual in-line stabilisation (MILS) have a higher incidence of difficult or failed intubations.
To compare the effectiveness of the Macintosh laryngoscope with three other intubating devices in a high fidelity simulation model.
Cross-over, simulation-based study.
Tertiary referral and level 1 trauma centre between June and November 2011.
Thirty-five experienced airway physicians.
Each participant performed tracheal intubations on a Laerdal SimMan manikin in both a normal airway and a difficult airway scenario with MILS. The devices utilised in a randomised order were the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway (iLMA).
The primary outcome was time to intubation. Success rates, grade of laryngoscopy and force of intubation were also measured.
One hundred and forty intubations were attempted by 35 participants in both the normal and MILS scenarios. In the normal airway, there was no difference in success rates and time to intubation. In the difficult airway with MILS, there was no difference in success rates. However, the Airtraq was associated with a longer time to intubation than the Macintosh, McCoy and iLMA, 39.3, 26.7, 23.3, 39.3, 22.8 s, respectively (P < 0.0001). The Airtraq delivered the best glottic view and lowest force of intubation in both scenarios (P < 0.0001), but was associated with the only failed intubation in the study. The McCoy was associated with a significant improvement in the glottic visualisation (P < 0.05) and reduction in the force of intubation (P <0.0001) compared with the Macintosh.
In this manikin study, the McCoy demonstrated multiple advantages over the Macintosh. The iLMA was associated with the fastest time to intubation and minimum force of insertion.
接受手动直线稳定（MILS）插管的多系统创伤患者插管困难或失败的发生率较高。
在高保真模拟模型中比较 Macintosh 喉镜与其他三种插管设备的效果。
交叉、基于模拟的研究。
2011 年 6 月至 11 月期间的三级转诊和一级创伤中心。
35 名经验丰富的气道医师。
每位参与者均在 Laerdal SimMan 模拟人身上进行了气管插管，在正常气道和 MILS 下的困难气道场景中使用了 Macintosh、McCoy、Airtraq 喉镜和插管喉罩气道（iLMA）。
主要结局为插管时间。测量成功率、喉镜分级和插管力度。
35 名参与者在正常和 MILS 场景中各尝试了 140 次插管。在正常气道中，成功率和插管时间无差异。在有 MILS 的困难气道中，成功率无差异。然而，Airtraq 与 Macintosh、McCoy 和 iLMA 相比，插管时间更长，分别为 39.3、26.7、23.3、39.3、22.8s（P<0.0001）。在两种情况下，Airtraq 提供了最佳的声门视图和最低的插管力度（P<0.0001），但与研究中的唯一一次插管失败有关。与 Macintosh 相比，McCoy 与声门可视化的显著改善（P<0.05）和插管力度的降低（P<0.0001）有关。
在这项模拟研究中，McCoy 与 Macintosh 相比表现出多个优势。iLMA 与最快的插管时间和最小的插入力有关。
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