Laryngoscopy via Macintosh blade versus GlideScope: success rate and time for endotracheal intubation in untrained medical personnel.

摘要

BACKGROUND: Tracheal intubation is the preferred technique to secure the airway and apply mechanical ventilation. However, when performed by untrained medical personnel, tracheal intubation via direct laryngoscopy has a high rate of failure. The GlideScope (Verathon Medical Europe, Ijsselstein, Netherlands) technique improves the success rate for difficult tracheal intubation performed by experienced physicians; whether this technique improves the success rate for normal intubations when performed by inexperienced personnel as well is unknown. Therefore, the authors compared the success rate of direct laryngoscopy versus the GlideScope technique performed by personnel inexperienced in tracheal intubations. METHODS: Twenty volunteers, who had had only manikin training for tracheal intubation, attempted 5 intubations with either technique in patients scheduled for general anesthesia within a time limit of 120 s. RESULTS: Two hundred patients were divided into 2 groups for intubation via direct laryngoscopy (n = 100) or the GlideScope technique (n = 100). Between groups, there was neither a clinically relevant difference in the anthropometric data nor in the medication used for anesthesia. The overall success rate was 93% for the GlideScope technique versus 51% for direct laryngoscopy (P < 0.01). Time for intubation was 89 +/- 35 s for direct laryngoscopy versus 63 +/- 30 s for GlideScope technique (P < 0.01). CONCLUSION: Tracheal intubation is the preferred technique to secure the airways in patients with a high risk of aspiration and is important in emergency medicine. Direct laryngoscopy with the Macintosh blade has a success rate of only 51% in our subjects. Using the GlideScope technique, a success rate of more than 90% within 120 s can be achieved after the first attempt, even in personnel untrained in intubation.