A comparison of Vie Scope and standard Macintosh laryngoscopes in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation - A randomised, controlled manikin trial

Tracheal intubation remains the gold standard in the management of the injured. Airway management of trauma patients, especially in pre-hospital settings is often challenging and may be associated with serious complications. In the current practice, standard laryngoscopes are being superseded by new generation devices such as video laryngoscopes. One of the recently-introduced airway devices is the Vie Scope. It is an illuminated intubating device with a design similar to Miller's straight intubating blade. The intubation technique using the Vie Scope requires the use of a bougie, which is inserted first and then after removing the scope the endotracheal tube is railroaded over the introducer. The aim of this study was to evaluate the Vie Scope for intubation in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. An intubation manikin with the cervical collar on was placed on and secured to the driver's seat of a passenger car. The car was then positioned on its left side. The time required to insert the device and achieve a successful glottic visualisation as well as the intubation and successful ventilation time were recorded. The glottic view was assessed using the Cormack-Lehane classification. The first attempt success rate of intubation and the ease of use by the operator were also assessed. Fifty fully qualified and experienced paramedics participated in the study. The standard Macintosh laryngoscope required shorter mean time to obtain the glottic view 12.7 s (±4.64) vs. 18.8 s (±5.86), p < 0.0001, however, better view of the glottis was obtained with the Vie Scope. The time to intubation and successful ventilation was significantly shorter when the Macintosh laryngoscope was used 35.03 s (±5.27) vs. 51.1 s (±6.28), p = 0.02. There were no failed intubation attempts when the Macintosh laryngoscope was used. Although the Vie Scope provided better glottic visualisation, because of the specific technique, the Macintosh laryngoscope was superior in terms of the time required to visualise the glottis, the time to intubation and successful ventilation. Moreover, the Macintosh laryngoscope was found to be easier and more convenient to use.