First comparison of the VennerTM A.P. AdvanceTM versus the Macintosh laryngoscope for intubations by non-anaesthetists: A manikin study

Objective: The present study aims to study whether using a videolaryngoscope (A.P. Advance™) facilitates or hinders intubation by non-anaesthetists inexperienced in its use. Methods: Thirty doctors from Emergency and Intensive Care Medicine backgrounds performed laryngoscopy and tracheal intubation using the Macintosh laryngoscope (MAC), A.P. Advance™ Normal Blade (AP N) and A.P. Advance™ Difficult Airway Blade (AP DAB) in simulated normal and difficult airway manikins. The primary outcomes measured were time to successful tracheal intubation and failure to intubate within 3min or three attempts. Secondary outcomes were number of intubation attempts, adjuncts used, glottic view and ease of intubation. Results: There was a higher rate of failed intubation in the simulated difficult airway in participants using the AP N blade than either the MAC or AP DAB (23% vs 3% and 7%, P = 0.031). This was associated with a longer median time to intubate with the AP N and the AP DAB versus MAC (56.6, 50.2 vs 39.9s, P = 0.007 and P = 0.041). In the normal airway median time to intubate was longest with the AP N (27.8s), and this was significantly slower than the MAC (18.1s, P = 0.003) and the AP DAB (17.3s, P <0.001). No one failed to intubate the normal manikin. Conclusions: The use of the A.P. Advance™ videolaryngoscope should not be considered, without adequate prior training and experience, in the management of a difficult airway. The level of adequate training has yet to be established. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.