First comparison of the Venner(TM) A.P. Advance(TM) 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 3 min 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 39.9 s, P = 0.007 and P = 0.041). In the normal airway median time to intubate was longest with the AP N (27.8 s), and this was significantly slower than the MAC (18.1 s, P = 0.003) and the AP DAB (17.3 s, 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.