Can the right video laryngoscope help you prevent difficult intubations? Difficult intubations can often lead to dire consequences for your patients, including hypoxia and cardiac arrest. A recent trial shows that the McGRATH™ MAC video laryngoscope can help you improve first-attempt intubation success — helping you keep patients safe.
Difficult intubations often happen without warning
Defined difficult intubations† are rare, occurring in one to four percent of all cases.2,3 Preoperative evaluation of the airway is routinely performed in order to identify difficult airways. However, a recent study of 188,064 intubation attempts found that 93 percent of difficult intubations‡ are unanticipated.2 Nearly 75 percent of airway-related adverse events occur in patients who are categorized as routine, with an ASA I or II rating.4 Furthermore, tests for predicting difficult intubations often perform poorly. A meta-analysis of studies evaluating the predictive value of tests for difficult airways revealed surprisingly low sensitivity of these tests (Table 1).1 As the consequences of difficult intubations can be significant (Table 2), clinicians should consider techniques that facilitate a high likelihood of first-pass intubation success.
Compared to both direct laryngoscopy and other video laryngoscopes, the McGRATH™ MAC video laryngoscope’s improved glottic visualization helps clinicians improve first pass success rate.5,6 This isn’t surprising given the utility of video laryngoscopy as a rescue technique where direct laryngoscopy fails. A retrospective review of 1,427 cases of failed direct laryngoscopy performed by 1,009 anesthesiologists found that video laryngoscopy is the most frequently selected and successful rescue technique.7
Use of the McGRATH™ MAC video laryngoscope has been shown to improve first-pass success* during intubation in a multicenter, randomized controlled trial.6
Improve first-pass intubation success with routine use of McGRATH™ MAC video laryngoscopy
The EMMA (Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation (NCT02611986)) trial was performed across eight divisions in two hospitals.** 8 It examined 2171 patients having elective surgery with general anesthesia who were randomized to be intubated with either:
- Macintosh laryngoscope (DL)
- McGRATHTM MAC video laryngoscope
The primary outcome measure was the number of patients successfully intubated during the first attempt. Secondary endpoints included:
- Time to intubation
- Number of attempts
- Failures/use of other rescue attempts
- External laryngeal manipulations
- Glottic view
- Rate of intubation difficulty score >5
- Ease of tracheal intubation
Results for the trial were presented in abstract form at the 2019 World Airway Management meeting in Amsterdam.6 A total of 2,171 patients — 1,084 in the McGRATH™ MAC video laryngoscope group and 1,087 in the direct laryngoscopy group — were included in the study. The McGRATH™ MAC video laryngoscope performed favorably for the first-pass success rate and rate of intubation difficulty score >5 endpoints (See Figures 1 and 2). While time to intubation was slightly shorter in the direct laryngoscopy group (34 vs. 36 seconds, p=0.0005), the difference was not clinically relevant. There was no difference between the groups in the number of adverse events. However, there was a trend (P>0.05) toward less injury — particularly in soft tissues — with the McGRATH™ MAC video laryngoscope.
Designed for everyday use
Not only does the McGRATH™ MAC video laryngoscope improve first-attempt intubation success — it’s also specially designed to endure in the fast-paced hospital environment.9 And, at an effective cost, it’s within reach for every intubation. 10
The unique design of the McGRATH™ MAC video laryngoscope capitalizes on the the traditional laryngoscopy skill that you have honed through years of experience. And, with one handle and multiple blade options, it helps you treat a range of routine intubation patients from pediatric to adult.11-13
With its unique design and durability, the McGRATH™ MAC video laryngoscope is a clear choice for all of your intubation needs.
The right fit for your facility
The McGRATH™ MAC video laryngoscope strikes a balance between performance and compact size. It has a much smaller footprint than other video laryngoscopes — making it completely portable. The compact screen provides the visual clarity you need without requiring you to take your attention off of the patient. Coupled with higher first-attempted success rates, this design helps you to optimize your patients’ experience.
† >2 attempts
‡ ≥ 3 attempts
*Compared to direct laryngoscopy
**Johannes Gutenberg-University, Mainz, Germany and Western University, London, ON, Canada
1. Roth D, Pace NL, Lee A, et al. Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review. Anaesthesia. 2019;74(7):915-928.
2. 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.
3. Oriol-Lopez S, Hernandez-Mendoza M, Hernandez-Bernal C, Alvarez-Flores A. Assessment, prediction and occurance of difficult intubation. Anestesiologia. 2009;32(1):41-49.
4. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British journal of anaesthesia. 2011;106(5):617-631.
5. Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. British journal of anaesthesia. 2016;116(5):670-679.
6. Kriege M, Noppens RR. Evaluation of the McGRATH™ MAC and Macintosh laryngoscope for tracheal intubation. British journal of anaesthesia. 2020;125(1):e209.
7. Aziz MF, Brambrink AM, Healy DW, et al. Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group. Anesthesiology. 2016;125(4):656-666.
8. Kriege M, Alflen C, Tzanova I, Schmidtmann I, Piepho T, Noppens RR. Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol. BMJ Open. 2017;7(8):e016907-e016907.
9. Based on internal test report #REP352, Drop test (hand held) of McGRATH MAC video laryngoscope (001-015-000 revision).
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.
11. Gaszyński T. Comparison of the glottic view during video-intubation in super obese patients: a series of cases. Therapeutics and clinical risk management. 2016;12:1677-1682.
12. Ross M, Baxter A. Use of the new McGrath(®) MAC size-1 paediatric videolaryngoscope. Anaesthesia. 2015;70(10):1217-1218.
13. 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. The American journal of emergency medicine. 2016;34(8):1338-1341.