Is McGrath® MAC better than Glidescope® Ranger for novice providers in the simulated difficult airway? A randomized manikin study

Abstract

Purpose of this study: McGrath® MAC and Glidescope® Ranger are portable video laryngoscopes that are easy to learn for novice and useful in difficult airway environment. We anticipated that McGrath® MAC would show performance in intubation of novices as equal as Glidescope® Ranger in normal and difficult airway.

Materials and Methods: Primary outcomes were the rate of successful intubation, intubation time and overall glottic view of McGrath® MAC, Glidescope® Ranger and Macintosh. We performed a prospective, single-blinded, randomized crossover study of 39 medical students using three laryngoscopes in a manikin, with simulated normal and difficult airway scenarios.

Results: The successful intubation rate of McGrath® MAC (82.5 (38.5)%) was better than Macintosh (57.5 (50.1)%; p = 0.026) and equal to Glidescope® Ranger (85 (36.2)%) at first attempt of easy scenario. However, McGrath® MAC was equal to Macintosh and Glidescope® Ranger from second to fifth attempt. The intubation time of McGrath® MAC (24.4 (14.7) s) was also equal to Glidescope® Ranger (22.2 (8.7) s) and Macintosh laryngoscopes (25.4 (12.2) s). The glottic view of McGrath® MAC (1 (1–1)) was superior to Macintosh (2 (1–2); P = 0.000) and equal to Glidescope® Ranger (1 (1-1)).

Novices achieved an equal successful intubation rate when using the McGrath® MAC (94.9 (22.1)%) comparing with Glidescope® Ranger (93.3 (25)%) and Macintosh (92.3 (26.7)%) in difficult scenario (p = 0.725). Intubation times were also similar for three laryngoscopes and became shorter with practice (p = 0.000). The view at laryngoscopy with the McGrath® MAC was better than Macintosh (p = 0.000) and not superior to Glidescope® Ranger (p = 0.001).

Conclusions: The rate for successful intubation and intubation time with McGrath® MAC in novices were equal to Glidescope® Ranger and Macintosh laryngoscope. Novices achieved a better glottic view with McGrath® MAC than Macintosh and not in comparison to Glidescope® Ranger in both of airway environments.