Comparison of four channelled videolaryngoscopes to Macintosh laryngoscope for simulated intubation of critically ill patients: the randomized MACMAN2 trial

Background Videolaryngoscopes with an operating channel may improve the intubation success rate in critically ill patients. We aimed to compare four channelled videolaryngoscopes to the Macintosh laryngoscope used for intubation of a high-fidelity simulation mannikin, in a scenario that simulated critical illness due to acute respiratory failure. Results Of the 79 residents who participated, 54 were considered inexperienced with orotracheal intubation. Each participant used all five devices in random order. The first-pass success rate was 97.5% [95% CI 91.1-99.7] for Airtraq (TM), KingVision (TM), and Pentax AWS200 (TM), 92.4% [95% CI 84.2-97.2] for VividTrac VT-A100 (TM), and 70.9% [95% CI 59.6-80.6] for direct Macintosh laryngoscopy. The first-pass success rate was significantly lower with direct Macintosh laryngoscopy than with the videolaryngoscopes (p < 0.0001 for Airtraq (TM), KingVision (TM), Pentax AWS200 (TM), and VividTrac VT-A100 (TM)). Conclusion The Airtraq (TM), KingVision (TM), and Pentax AWS200 (TM) channelled videolaryngoscopes produced high first-pass success rates with a lower boundary of the 95% CI above 90%. A multicentre, randomised controlled clinical study comparing channelled videolaryngoscopy to direct laryngoscopy should include one of these three videolaryngoscopes.

Automated summary

The study compared four channelled videolaryngoscopes to the Macintosh laryngoscope for intubation in a simulated scenario of critical illness. Results showed that the Airtraq, KingVision, and Pentax AWS200 videolaryngoscopes had significantly higher first-pass success rates compared to direct Macintosh laryngoscopy, indicating their potential use in future clinical studies comparing videolaryngoscopy to direct laryngoscopy.