A randomized multi-institutional crossover comparison of the GlideScope® Cobalt Video laryngoscope to the flexible fiberoptic bronchoscope in a Pierre Robin manikin

1. Pediatric Anesthesia   
2. John E. Fiadjoe^1,*, 
3. Matthew Hirschfeld¹, 
4. Stephan Wu¹, 
5. James Markley¹, 
6. Harshad Gurnaney¹, 
7. Abbas F. Jawad¹, 
8. Paul Stricker¹, 
9. Todd Kilbaugh¹, 
10. Patrick Ross² and
11. Pete Kovatsis³

Article first published online: 27 APR 2015
DOI: 10.1111/pan.12668

The Manikin study reported by John Fiadjoe et. al. illustrates findings that possibly indicate ease of learning the device handling features of equipment rather than effectiveness of the VL and FOB devices in the Pierre Roban complex . The jump from Manikin to Actual patient care is significant and is affected by secretions, relaxation, and muscular tone. 

This study did show that an institutional difference in results was apparent suggesting the need for disciplined training to achieve optimal results. The people are being measured as well as the devices in question. This study comes from a very experienced group of paediatric airway managers.

Summary

Background

The GlideScope Cobalt Video laryngoscope is being used more often in children with challenging laryngoscopy. There are, however, no pediatric trials comparing it to flexible fiberoptic bronchoscopy, the current accepted gold standard. This preliminary manikin study compares the first-attempt intubation success of the GlideScope Cobalt video laryngoscope to the flexible fiberoptic bronchoscope when performed by attending pediatric anesthesiologists at two major pediatric centers.

Methods

This prospective randomized, crossover study evaluated 120 attempts (60 with each study device) to intubate the AirSim Pierre Robin manikin (PRM) with fiberoptic bronchoscopy and video laryngoscopy (VL). Attending pediatric anesthesiologists from two quaternary pediatric centers were eligible to participate. Each attending anesthesiologist randomly performed a single tracheal intubation attempt with one of the study devices followed by the alternate method. The primary outcome was the first-attempt success rate of tracheal intubation. Blinding was not feasible. We hypothesized that first-attempt success would be higher with fiberoptic bronchoscopy.

Results

Thirty anesthesiologists from each center were randomized to use one of the study devices followed by the alternate method. We analyzed all participants' data. There was no overall difference in first-attempt success between VL and fiberoptic bronchoscopy (88.3% vs 85% respectively, P = 0.59). There were significant institutional differences in first-attempt success using VL (76.7% vs 100%).

Conclusions

There was no difference in first-attempt success of tracheal intubation using VL vs fiberoptic bronchoscopy when performed by attending anesthesiologists at two large pediatric centers. However, institutional differences exist in success rates with VL across the two centers. Results from single-center device evaluations should be verified by multi-center evaluations. A significant proportion of attending anesthesiologists lack experience with advanced airway devices; targeted education may enhance intubation success and patient safety.