Detoni Pablo B, Nascimento Jedson S, Araújo Azi Liana M T, Pustilnik Alexandre G, Gusmão-Cunha André, Módolo Norma Sueli P, Campos Guilherme O, de Almeida Victor S, Cambui João Pedro M M, de Almeida Vinicius S, Alves Rodrigo L
From the Department of Surgical Specialties and Anesthesiology of São Paulo State University (UNESP), Medical School, Botucatu, Brazil.
Department of Anesthesiology, Santa Casa de Misericórdia Bahia, Salvador, Brazil.
Anesth Analg. 2025 Feb 1;140(2):334-341. doi: 10.1213/ANE.0000000000007067. Epub 2024 Sep 19.
Proficiency in endotracheal intubation (ETI) is essential for medical professionals and its training should start at medical schools; however, large caseload may be required before achieving an acceptable success rate with direct laryngoscopy. Video laryngoscopy has proven to be an easier alternative for intubation with a faster learning curve, but its availability in medical training may be an issue due to its high market prices. We devised a low-cost 3-dimensionally printed video laryngoscope (3DVL) and performed a randomized trial to evaluate if the intubation success rate on the first attempt with this device is noninferior to a standard commercially available video laryngoscope (STVL).
Two hundred and nine medical students from 5 medical schools were enrolled and randomized to start with the STVL (McGrath MAC) or the 3DVL. Four stations (standard airway using the STVL/3DVL and difficult airway using the STVL/3DVL) were set to simulate ETI with standard Airway Management Trainer manikins (Laerdal Medical Ltd.). The noninferiority margin of 7.5% was defined for the success rate on the first attempt, considering the difference in proportions between the STVL (expected to be higher) and 3DVL groups.
Regarding the standard airway station, 60.7% (n = 65) of the students successfully performed TI on the first attempt with the STVL within the established timeframe, compared to 36.3% (n = 37) of the students using the 3DVL. This represented a difference of 24.4% (95% confidence interval, 17.5%-31.3%). Considering the difficult airway station, the success rates on the first intubation attempt with the 2 VLs did not differ.
The 3DVL was inferior in achieving first-attempt intubation when compared with the STVL with a difference in success rate >7.5% margin in simulated scenarios with medical students. Tracheal intubation might require a set of psychomotor skills for which the McGrath MAC device is superior to the low-cost alternative.
气管插管（ETI）技能对医学专业人员至关重要，其培训应在医学院校开始；然而，在通过直接喉镜检查达到可接受的成功率之前，可能需要大量病例。视频喉镜已被证明是一种更容易的插管替代方法，学习曲线更快，但由于其高昂的市场价格，其在医学培训中的可用性可能是一个问题。我们设计了一种低成本的三维打印视频喉镜（3DVL），并进行了一项随机试验，以评估使用该设备首次尝试插管的成功率是否不低于标准的商用视频喉镜（STVL）。
招募了来自5所医学院校的209名医学生，并随机分为先使用STVL（麦格拉斯MAC）或3DVL组。设置了四个站点（使用STVL/3DVL的标准气道和使用STVL/3DVL的困难气道），使用标准气道管理训练模拟人（Laerdal Medical Ltd.）模拟ETI。考虑到STVL（预期较高）和3DVL组之间的比例差异，首次尝试成功率的非劣效性界限定义为7.5%。
在标准气道站点，60.7%（n = 65）的学生在既定时间内使用STVL首次尝试成功进行了气管插管，而使用3DVL的学生为36.3%（n = 37）。这代表了24.4%的差异（95%置信区间，17.5%-31.3%）。在困难气道站点，两种视频喉镜首次插管尝试的成功率没有差异。
在与医学生进行的模拟场景中，与STVL相比，3DVL在首次尝试插管方面较差，成功率差异>7.5%界限。气管插管可能需要一系列心理运动技能，对于这些技能，麦格拉斯MAC设备优于低成本替代品。
