A Mannequin Study of Intubation with the AP Advance and GlideScope Ranger Videolaryngoscopes and the Macintosh Laryngoscope

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A Mannequin Study of Intubation with the
APAdvance and GlideScope Ranger
Videolaryngoscopesand the Macintosh Laryngoscope

• Elisa Brunetto BSN, RN, SRNA
• Journal Club
• Winter 2012

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• Brewer, E.J., Cata, J., Dalton, J.E., Doyle,
  D.J., Hodd, J.A., James, M. Sessler, D.I.
  (2011). A mannequin study of intubation with the
  AP Advance and GlideScope Ranger
  Videolaryngoscopes and the Macintosh
  Laryngoscope. AANA, 111(13), 791-800.

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Introduction

• October 2011 AANA journal
• Conducted at Cleveland Clinic
• IRB approved
• Clinicians who might intubate during their
  clinical practice were eligible
• Group 1 medical students and clinicians with
  little to no experience
• Group 2 Paramedical and medical staff with
  experience using MAC blades
• Group 3 anesthesia provides with GlideScope and
  MAC blade experience

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Purpose

• Assess if the AP Advance (APA) takes the same
  amount of time as a MAC blade to intubate normal
  airways and a GlideScope with difficult airways
  on a mannequin

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Background

• AP advance
• Videolaryngoscope
• Has interchangeable blades (Traditional MAC blade
  or difficult airway blade with increased
  curvature and channel to guide tube into the
  airway)

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Background

• MAC Blade
• Chosen because it is ubiquitous and highly
  effective in normal airways
• First blade chosen for beginners
• Glidescope
• Selected for its proved efficacy and ease of use
  over other alternative airway techniques

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Study

• Each participate received the manufactures
  instructions for the device as well as a demo
• Participants were then allowed to practice each
  device on a normal airway mannequin

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Study

• Envelope blinded participates to scope and airway
  order until the start of the study
• Timing started when participate first touched
  airway equipment

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Study

• Failed airway
• Unrecognized esophageal intubations
• Abandoned procedures
• Intubations that took greater then 120 sec
• Intubations that required more then 3 attempts

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Study

• Failed attempt
• Removal of airway equipment without successful
  intubation
• Number of attempts and failed intubations was
  recorded

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Study

• Potential damage
• Assessed by comparing number of misdirected
  advances of the ET tube
• Ease of glottic view
• Measured by recording time required by
  participants to say they had the best view
• Time required to place tube after view obtained
  was recorded

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Study

• Participants
• Asked to recommend device for use in normal
  airway, difficult airway, single device for all
  intubations
• Rate GlideScope and AP Advance on portability,
  light source, picture quality, and position of
  screen

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Statistical Analysis

• Stratified Cox regression model was used for each
  airway
• Based on adjusted categories on participants
  experience
• Enrolled 90 participants which was 50 more then
  previous studies using the AP Advance
• Significance at gt0.8

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Results

• Normal airway mannequin
• Intubation times were longer with GlideScope then
  other two devices
• Intubation time for AP advance was 22 sec and 23
  sec for the glideScope
• AP advance had one failure, GlideScope 5, MAC
  blade 3
• AP advance 7 times more likely to have a better
  view more quickly

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Results

• Difficult airway
• AP Advance required least time followed but
  GlideScope and finally MAC blade
• 20 sec for AP advance vs 59 sec GlideScope
• AP advance had no failures, GlideScope 30 (33),
  MAC blade 33 (37)

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Results

• AP Advance caused less damage to glottis
• 82 of users would chose the AP Advance if they
  had only one device for use
• Preferred screen position and portability

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Strengths

• Mannequin used provided that the same airway was
  used for each device and practitioner
• Device that was to be used was blinded to
  participants
• Participants all received an opportunity to
  practice with the device before using in the study

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Weakness

• Mannequins fail to have the same texture of human
  tissues
• Didnt take into account cost for devices
• GlideScope 11,000, 15 per blade
• AP Advance 7500, 45 per blade
• To many different skill levels were used
• Could have contributed to the high number of
  failed intubations due to the novice skill set

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Implications to Practice

• Use the AP Advance when available at facilities
• Encourage facilities to purchase AP Advance if
  budgeting allows