Abstract
BACKGROUND: The technique of visualizing the vocal cords during direct laryngoscopy has made the Macintosh laryngoscope (HEINE Optotechnik GmbH & Co. KG, Gilching, Germany) the optimal choice for endotracheal intubation since the middle of the 20th century. On the other hand, the use of full personal protective equipment during the SARS-CoV-2 pandemic impeded the successful completion of medical procedures, such as endotracheal intubation during cardiopulmonary resuscitation in patients infected with COVID-19. These circumstances necessitated the development of a new type of laryngoscope, the Vie Scope (Adroit Surgical LLC, Oklahoma City, OK, USA). MATERIALS AND METHODS: A single-blind, randomized, prospective, superiority clinical trial was conducted. Patients with an expected easy airway were enrolled and allocated in a 1:1 ratio to either the Vie Scope or Macintosh. The first-attempt intubation success rate and the required intubation time were defined as primary outcome measures, while the overall intubation success rate and glottis visualization, as classified by the Cormack-Lehane scale, were considered secondary outcomes. RESULTS: This study included 264 patients. The required intubation time was shorter with the Macintosh than with the Vie Scope (median (interquartile range (IQR)): 7.80 (1.50) and mean (standard deviation (SD)): 8.08 (5.34) seconds vs. median (IQR): 15.65 (3.90) and mean (SD): 16.65 (5.02) seconds, difference in means: 8.60 seconds, 95% CI: -∞ to 7.9, p<0.0001). The first-attempt intubation success rate was estimated at 100% (132/132) and 90.15% (119/132) using the Macintosh and Vie Scope, respectively (relative risk: 0.90 (=1/1.1, 95% CI: 0.85-0.95), p=0.0002). Furthermore, a higher overall intubation success rate was noted with the Macintosh (132/132, 100%) than with the Vie Scope (124/132, 93.94%), p=0.0041. No statistically significant difference was detected between the laryngoscopes regarding the degree of the glottis visualization (p=0.7895). CONCLUSIONS: The first-attempt and overall intubation success rates, as well as the required intubation time with the Macintosh, were superior to those with the Vie Scope when used for the establishment of anticipated easy airways, without a statistically significant difference in glottis visualization grade.