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Comparing Cart-Based and Handheld Video Laryngoscopes

Key Differences Between Cart-Based and Handheld Video Laryngoscopes

When you’re evaluating video laryngoscopes, it’s important to understand and compare the choices so you can make an informed decision. You encounter different types of patients who present different intubation challenges — and you want to do your best to avoid airway complications. Complications can occur when you least expect them1,2 and can be associated with patient morbidity and unnecessary expense.3-5

In this article, we’ll discuss cart-based video laryngoscopes and handheld video laryngoscopes. The McGRATH™ MAC handheld video laryngoscope may help you be better prepared for the unexpected. Read on to learn about features, functions, cost, performance, and outcomes.

Key Features of Video Laryngoscopes

While there are many considerations for choosing a video laryngoscope, you’ll want to explore these key features:

  • Blade designs and sizes. Do straight or curved blades provide a better fit for patients? And how many blade sizes are available? Using blades based on familiar Macintosh-like curvature may reinforce your existing direct laryngoscopy skills.
  • Single-use or multiple-use blades. Single-use blades eliminate cleaning and have the potential to reduce the risk of cross contamination, thereby enhancing patient safety.
  • Screen location. The cart-based video laryngoscope separates the laryngoscope from the camera, so clinicians must look away from the patient to view the screen. A screen on the handle of a portable video laryngoscope provides a direct line of sight.
  • Channel or no channel for tracheal tube guidance. Unchanneled blades are usually less bulky and may make it easier to maneuver the tracheal tube.6

Cart-Based Video Laryngoscopes

Cart-based video laryngoscopes have to be wheeled into the treatment room, which can be unwieldy. Cables have the potential to create safety concerns. The video screen, which is separate and off to the side of the patient, takes the operator’s view away from the line of axis.

Many hospitals cannot afford to put a cart-based video laryngoscope in or near every OR, limiting use to difficult airways. Why not have a product within reach that’s suitable for all intubations? Learn more about the costs associated with video laryngoscopes.

Related: Watch a classic laryngoscope evolve into an easy-to-use video laryngoscope

Handheld Video Laryngoscope

The handheld McGRATH™ MAC video laryngoscope is the only video laryngoscope with a screen on the handle that provides a portrait view. It combines line-of-sight video in the display with the familiar Macintosh technique. So you retain your traditional laryngoscopy skills.

The slim, curved design opens up more room in the oral cavity, which leads to reduced dental and soft tissue trauma.6  With multiple sterile, disposable blade options, the McGRATH™ MAC video laryngoscope can be used for pediatric to adult patients and routine to extreme airways.7-9

The McGRATH™ MAC video laryngoscope is portable and cost effective for ORs, ICUs, and emergency kits, making critical video laryngoscope technology accessible for any intubation.10 Each unit currently can cost around $1,000 when purchased in bulk.

Related: Watch the video of a pediatric anesthetist describing the benefits of using a handheld video laryngoscope.

Hospital and Clinical Outcomes

The findings of clinical studies can help you determine which video laryngoscope best fits your objectives, including cost and patient outcomes. Difficult intubations contribute to about $2 billion in increased annual costs in the United States alone based on reported incidence and ICD-10 costs analysis.2,11-13 After two laryngoscopy attempts, the rates of aspiration and cardiac arrest increase by 13 and 11 percent, respectively.5 Although approximately 80 percent of airway-related incidents resulted in a full recovery, 2 percent resulted in brain damage and 12 percent ultimately resulted in patient death.5

The McGRATH™ MAC video laryngoscope has been shown to provide:

  • Better glottic visualization than traditional Macintosh laryngoscopy14,15
  • Reduced intubation times, even with limited training14
  • Higher intubation success rates than other video laryngoscopes6

Compared to the King VisionTM* video laryngoscope, the McGRATH™ MAC video laryngoscope design is associated with a shorter time to intubation, higher first-attempt success rates, and fewer desaturations.16 And the McGRATH™ MAC video laryngoscope design is associated with lower tissue trauma rates compared to other video laryngoscopes.7

The McGRATH™ MAC video laryngoscope has also been shown to decrease the incidence of difficult intubations when compared to the traditional direct visualization technique.17

By comparing key features and assessing study results, you’ll be better prepared to evaluate which video laryngoscope best meets the needs of your facility ― and your patients.

Related: Watch a video of four global practitioners discussing their experience and best practices while using the McGRATH™ MAC video laryngoscope.


1. Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. 2015;70(3):272–281.
2. Huitink JM, Lie PP, Heideman I, et al. A prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre. Anaesthesia. 2017;72(1):42–48.
3. Fiadjoe JE, Nishisaki A, Jagannathan N, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37–48.
4. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims’ analysis. Best Pract Res Clin Anaesthesiol. 2011;25(2):263–76.

5. Cook T, Woodall N, Frerk C. 4th National Audit Project of the Royal College of Anaesthetists and The Difficult Airway Society: major complications of airway management in the United Kingdom. Published March 2011. Accessed January 2017.

6. M Kleine-Brueggeney, R Greif, P Schoettker, G.L. Svoldelli, S Nabecker, L.G. Theiler. Evaluation of six video laryngoscopes in 720 patients with a simulated difficult airway: a multicenter randomized controlled trial. Science Direct. Vol. 116, Issue 5, May 2016, Pages 670-679
7. Gaszyński T. Comparison of the glottic view during video-intubation in super obese patients: a series of cases. Ther Clin Risk Manag. 2016;12:1677–1682.
8. Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodríguez-Núñez A. A comparison of the McGrath-MAC and MACintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics: a randomized, crossover, manikin study. Am J Emerg Med. 2016;34(8):1338–1341.
9. Ross M, Baxter A. Use of the new McGrath MAC size-1 paediatric videolaryngoscope. Anaesthesia. 2015;70(10):1217–1218.
10. Alsumali A, Noppens R. Cost effectiveness of video laryngoscopy for routine use in the operating room. Trends in Anaesthesia and Critical Care. 2018;23:10. doi: 10.1016/j.tacc.2018.09.008.
11. Based on Millennium Research Group, report #RFP2238. 2012.
12. Oriol-Lopez SA, Hernandez-Mendoza M, Hernandez-Bernal CE, Alvarez-Flores AA. Assessment, prediction and occurrence of difficult intubation. Anestesiologia. 2009;32(1):41–49.
13. Based on internal Premier data analysis for median cost associated with difficult intubation ICD10 codes. 2015-2017.
14. Shin M, Bai SJ, Lee KY, Oh E, Kim HJ. Comparing McGRATH MAC, C-MAC®, and Macintosh laryngoscopes operated by medical students: a randomized, crossover, manikin study. Biomed Res Int. 2016;2016:8943931.
15. Yoo JY, Park SY, Kim JY, Kim M, Haam SJ, Kim DH. Comparison of the McGrath video laryngoscope and the MACintosh laryngoscope for double lumen endobronchial tube intubation in patients with manual in-line stabilization: a randomized controlled trial. Medicine (Baltimore). 2018;97(10):e0081.
16. Alvis BD, Hester D, Watson D, Higgins M, St Jacques P. Randomized controlled trial comparing the McGRATH MAC video laryngoscope with the King Vision video laryngoscope in adult patients. Minerva Anestesiol. 2016;82(1):30–35.
17. De Jong A, Clavieras N, Conseil M, et al. Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study. Intensive Care Med. 2013;39: 2144–2152.

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TOPIC: McGRATH™ MAC Video Laryngoscope

About the Author

Jackson Adams is an Operating Room Market Strategist for Respiratory and Monitoring Solutions at Medtronic.

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