Hiroshi Hoshijima1, Takahiro Mihara2, Koichi Maruyama3, Yohei Denawa4, Masato Takahashi5, Toshiya Shiga6, Hiroshi Nagasaka5. 1. Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan. Electronic address: hhoshi@saitama-med.ac.jp. 2. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan. 3. Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan. 4. Department of Anesthesiology, Allegheny Health Network, PA, USA. 5. Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan. 6. Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan.
Abstract
STUDY OBJECTIVE: The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. DESIGN: Meta-analysis and systematic review. SETTING: Operating room or intensive care unit. MEASUREMENTS: A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). MAIN RESULTS: Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. CONCLUSIONS: Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.
STUDY OBJECTIVE: The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. DESIGN: Meta-analysis and systematic review. SETTING: Operating room or intensive care unit. MEASUREMENTS: A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). MAIN RESULTS: Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. CONCLUSIONS: Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.
Authors: Marc Kriege; Philipp Lang; Christoph Lang; Nina Pirlich; Eva-Verena Griemert; Florian Heid; Eva Wittenmeier; Irene Schmidtmann; W Schmidbauer; Christoph Jänig; Johannes Jungbecker; Oliver Kunitz; Maximilian Strate; Axel Schmutz Journal: BMJ Open Date: 2021-10-06 Impact factor: 2.692
Authors: Kurt Ruetzler; Lukasz Szarpak; Jacek Smereka; Marek Dabrowski; Szymon Bialka; Lauretta Mosteller; Agnieszka Szarpak; Kobi Ludwin; Marzena Wojewodzka-Zelezniakowicz; Jerzy Robert Ladny Journal: Biomed Res Int Date: 2020-02-18 Impact factor: 3.411
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