The use of video laryngoscopy during air medical transport: a manikin study

This study simulated intubation with direct laryngoscopy and with a GlideScope Ranger video laryngoscope using a standard Laerdal airway manikin in a medical helicopter under various conditions. We hypothesized that the intubation times would be greater using direct laryngoscopy compared with the GlideScope under all conditions.

Twenty crew members of a single helicopter emergency medical service participated in the study. Participants intubated an airway manikin using both direct laryngoscopy and the GlideScope Ranger in varying conditions, including standing in a room with the lights on and off, in the helicopter while stationary on the ground and unbelted during both daytime and nighttime, and finally in the aircraft while in flight belted during both daytime and nighttime. A study investigator recorded the intubation times and independently confirmed tracheal placement of the endotracheal tube.

For all 6 environments, the mean time for intubation was slightly greater using the GlideScope (18.7 seconds; 95% confidence interval, 17.4-20.0 seconds) compared with direct laryngoscopy (15.5 seconds; 95% confidence interval, 14.7-16.4). There was a statistically significant difference in times to intubation, in favor of direct laryngoscopy, in the settings of standing with the room lights on (P = 0.0013), on the ground in the helicopter unbelted during the daytime (P = 0.009), and in flight belted at nighttime (P = 0.0012), with the 3 other environments not reaching statistical significance.

Using the GlideScope took more time to intubate compared with direct laryngoscopy in all tested environments. Although this difference in intubation times was statistically significant, it was not clinically significant, suggesting that both modalities may be comparable in nondifficult airways.