Comparison of video laryngoscope with direct laryngoscope for endotracheal intubation by cardiology residents: A randomized cross-over manikin-based study

Background Critically ill cardiac patients may decompensate suddenly owing to arrhythmias and worsening haemodynamics, often necessitating emergent endotracheal intubation. Training in airway management is usually neglected for residents in the cardiac intensive care unit (ICU). There is an unmet need to train cardiology residents in the swift management of airways in the acute setting of a cardiac arrest. Methods In this manikin-based cross-over study, we compared King's vision channelled (KVC) and non-channelled video laryngoscopes (King's vision [KV]) with Macintosh direct laryngoscopes (DL) for endotracheal intubation by 89 resident doctors, predominantly cardiology residents. All participants performed endotracheal intubation by all three types of laryngoscopes after a didactic training session. The primary endpoint of the study was time to endotracheal intubation. Other parameters assessed were best glottic view, time to glottic view, ease of use of the device, failed attempts and retention of skills over 6 months. Results Total time to tracheal intubation was least with KVC, 10.0 (interquartile range [IQR] 6.0-10.0) seconds, as compared to KV, 15.0 (IQR 12.0-17.5) or DL, 24.0 (IQR 22.0-30.0) seconds (p<0.001). Both types of video laryngoscopes provided superior glottic view and had lower failure rates (p<0.001). KVC video laryngoscope and Macintosh DL were relatively easier to use (p<0.001). KVC and KV provided better retention of skills at 6 months. Conclusion Cardiology residents who were novices in endotracheal intubation took the least time for intubation on manikin with the KVC video laryngoscope when compared with the KV video laryngoscope and Macintosh DL. Further, real-life studies are needed to assess any difference in clinical situations.