Emergency intubation of infants: does laryngoscope blade design make any difference?

To compare intubation times and ease of use for a range of infant laryngoscope blades in the hands of accident and emergency (A&E) personnel.

Seven different blades were compared in terms of intubation times and ease of use scores in the hands of 30 A&E senior house officers (SHOs) and nurses using a standard infant manikin.

There was a significant difference in intubation times between the seven blades (p < 0.001). Intubation with two blade designs (Seward and Soper) took almost twice as long as for the other blades (p < 0.05). Subjective ease of use scoring also identified the Seward and Soper blades as being the most difficult to use (p < 0.05). There were no significant differences between SHO and nurse intubation times or ease of use scoring. Successful intubation was achieved within 30 seconds in 90% of attempts. All but two of the subjects used an incorrect levering technique for intubation despite all having previously received training in infant intubation.

No current standard exists regarding the utilisation of infant laryngoscope blades in the A&E department. The first line blade available should be a C shaped blade (Miller, Oxford, Robert-shaw, or Wisconsin). Other blade designs should be kept for use only by more experienced personnel or in difficult intubation situations. Intubation training must focus on correct technique and regular assessment is essential.