Purpose: Direct laryngoscopic tracheal intubation is a potentially lifesaving procedure, but a difficult skill to acquire and maintain. The consequences of poorly performed intubation attempts are potentially severe. The Pentax AWS and the Glidescope are indirect laryngoscopes that may require less skill to use. We therefore hypothesized that AWS and Glidescope would prove superior to the Macintosh laryngoscope when used by novices in the normal and simulated difficult airway.
Methods: In this prospective randomized crossover trial following standardized didactic instruction, medical students with no prior experience of laryngoscopy performed tracheal intubation using each device. Each student was allowed up to three attempts to intubate in a Laerdal Intubation Trainer in two laryngoscopy scenarios and in a Laerdal SimMan manikin in one scenario. The students then performed tracheal intubation of the normal airway a second time to characterize the learning curve for each device.
Results: The Pentax AWS provided better intubation conditions than the Glidescope or the Macintosh, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. The Glidescope demonstrated advantages over the Macintosh, particularly in the more difficult scenarios. Both the AWS and the Glidescope decreased the duration of intubation attempts, reduced the number of maneuvers required, and reduced the potential for dental trauma. In direct comparisons, the AWS provided the best intubation conditions.
Conclusions: The Pentax AWS appears to constitute a better alternative to the Macintosh for novice personnel to acquire the skills of tracheal intubation.