Evaluation of the Learning Curve of Endotracheal Intubation with Videolaryngoscopes: McGrathMAC, UESCOPE, and Airtraq by Young Anesthesiology Residents - Randomized, Controlled, Blinded Crossover Study

Pawel Ratajczyk,1 Przemyslaw Kluj,1 Krzysztof Wasiak,1 Jeremi Strzalek,1 Karolina Kolodziejska,2 Tomasz Gaszynski1 1Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 2II Department of Cardiology, Central University Hospital, Medical University of Lodz, Lodz, PolandCorrespondence: Pawel Ratajczyk; Tomasz Gaszynski, Email [email protected]; [email protected]: Videolaryngoscopes increased the safety of patients requiring endotracheal intubation. Their particular beneficiaries are healthcare providers inexperienced in intubation. We compared the learning curve of McGrath, UESCOPE, and Airtraq VLs among the first-year anesthesiology residents.Methods: Sixteen residents were qualified for the study, none of whom has ever before used any VL nor had any experience with the Macintosh laryngoscope. The study was conducted during anesthesia without anticipated intubation difficulties and included 288 adult patients with BMI < 25 and ASA ≤ II, without visible intubation difficulties. It was a randomized, controlled, and blinded crossover study. Each resident performed six intubations with a given VL in randomized order.Results: There were no statistically significant differences in patient characteristics. In McGrath there was observed significant improvement of intubation time, confirmed intubation time, ease, POGO scale, effective intubation, thyroid pressure application, and intubation trauma. Intubation efficacy increased from 12 (75%) at first attempt, to 16 (100%) during third and following attempts. Residents used pressure 6 times (38%) during first attempt and 7 times (44%) during second attempt, and 1 (6%) at last attempt. McGrath traumatism was noticed in 4 (25%) patients at first two attempts, none during third and following attempts. In Airtraq, we observed a significant improvement of intubation time, time of confirmed intubation, force used, ease, effective intubation, and application of pressure to thyroid cartilage. Intubation efficacy increased from 10 (62%) during the first to 16 (100%) during the following attempts. Thyroid pressure was applied 7 times (44%) during first intubation and 0 times during the last two attempts. In the case of UESCOPE VL, we observed a significant improvement of intubation time, time of confirmed intubation, force used, and ease.Conclusion: Results demonstrated that Airtraq VL having the best learning curve, and UESCOPE having the best first-time use. The results require confirmation in a larger study group. This study was approved on 14 November 2023 by the Medical University of Lodz Bioethics Committee (ref: RNN/160/23/KE).Keywords: videolaryngoscopy, VL, learning curve, endotracheal intubation, residents, teaching