Self-Assembled Modified Macintosh Videolaryngoscope Versus McGrath Macintosh (MAC®) Videolaryngoscope: Which is Better?
Condition: Airway Management
Study type: Interventional

Summary: 
      Videolaryngoscopy highly improves success rate for endotracheal intubation in both normal and
      difficult airway. However, commercially available videolaryngoscope such as McGrath MAC® can
      be costly.

      The. investigators aim to study a more economical alternative by comparing the intubation
      time, first attempt success rate, laryngeal visualization, complications, and user
      satisfaction between our self-assembled modified macintosh videolaryngoscope (SAM-VL) and
      McGrath MAC® (McGrath).

      The study shows that endotracheal intubation using self-assembled modified videolaryngoscope
      is faster, had more successful first attempts, and allowed better glottis visualization
      compared with McGrath MAC®. It is a suitable alternative for videolaryngoscope in low
      resource setting.
    

Detailed description: 
      Background and Aims: Videolaryngoscopy highly improves success rate for endotracheal
      intubation in both normal and difficult airway. However, commercially available
      videolaryngoscope such as McGrath MAC® can be costly. The investigators aim to study a more
      economical alternative by comparing the intubation time, first attempt success rate,
      laryngeal visualization, complications, and user satisfaction between our self-assembled
      modified macintosh videolaryngoscope (SAM-VL) and McGrath MAC® (McGrath).

      Settings and Design: This was a single-blind randomized clinical trial with 62 adult
      subjects. The investigators exclude patients with difficult airway, cardiac disease, and
      neuromuscular disease. The results were calculated using the Statistical Package for Social
      Scientists (SPSS) 24 Results: Median total intubation time was 63 s (27 - 114 s) in SAM-VL
      group, compared with 74 s (40 - 133 s), (p = 0,032) in McGrath group. The rate of successful
      first attempt in SAM-VL group was slightly higher than McGrath group at 90,3% vs 87.1%.
      Glottic visualization was more satisfactory in SAM-VL group with 67.7% of subjects having
      score of 100 and 29% of subject having score of 75. Complications found in this study were
      tachycardia (12.9% SAM-VL group vs 29% in McGrath group) and minimal airway mucosal
      laceration (9.7% in SAM-VL vs 3.2% in McGrath group). SAM-VL users rate the device high in
      ease of blade insertion and manoeuvrability, providing good laryngeal visualisation, and
      overall satisfaction rating.

      Conclusions: Endotracheal intubation using self-assembled modified videolaryngoscope is
      faster, had more successful first attempts, and allowed better glottis visualization compared
      with McGrath MAC®.

      Key-words: endotracheal intubation, self-assembled videolaryngoscope, McGrath MAC®,
      intubation time, glottis visualization Key Messages: Endotracheal intubation using
      self-assembled modified videolaryngoscope is faster, had more successful first attempts, and
      allowed better glottis visualization compared with McGrath MAC®. It is a suitable alternative
      for videolaryngoscope in low resource setting.
    

Intervention name(s): Endotracheal intubation
Intervention type(s): Device
Intervention description(s): Every eligible patient was intubated using either SAM-VL or McGrath MAC® according to their randomization allocation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There were 2 intervention groups: (1) the Self-Assembled Modified Macintosh Videolaryngoscope (SAM-VL) group or (2) the McGrath MAC ® videolaryngoscope (McGrath) group.
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: endotracheal intubation; self-assembled videolaryngoscope; McGrath MAC®; intubation time; glottis visualization