Impact of universal use of the McGrath videolaryngoscope as a device for all intubations in the cardiac operating room. A prospective before-after VIDEOLAR-CAR study

ABSTRACT Objective Tracheal intubation in cardiac surgery patients has a higher incidence of difficult laryngoscopic views compared to patients undergoing other types of surgery. We hypothesize that using the McGrath Mac videolaryngoscope as the first intubation option for cardiac surgery patients improves the percentage of patients with "easy intubation" compared with using direct Macintosh laryngoscope. Design A prospective, observational, before-after study. Setting At tertiary care hospital. Participants One thousand one hundred nine patients undergoing cardiac surgery. Intervention Consecutive patients undergoing cardiac surgery were intubated using as the first option a Macintosh laryngoscope (pre-interventional phase) or a McGrath Mac videolaryngoscope (interventional phase). Measurements and Main Results The main objective was to assess whether the use of the McGrath videolaryngoscope as the first intubation option improves the percentage of patients with "easy intubation", defined as successful intubation on the first attempt, modified Cormack-Lehane grades of I or IIa, and the absence of the need for adjuvant airway devices. A total of 1109 patients were included, 801 in the non-interventional phase and 308 in the interventional phase. The incidence of "easy intubation" was 93% in the interventional phase vs 78% in the non-interventional phase (P < 0.001). First-success rate intubation was higher in the interventional phase (304/308; 98.7%) compared to the non-interventional phase (754/801, 94.1%; P = 0.005). Intubation in the interventional phase showed a decrease in the incidence of difficult laryngoscopy (12/308 (3.9%) vs 157/801 (19.6%); P < 0.001), as well as moderate or difficult intubation (5/308 (1.6%) vs 57/801 (7.1%); P < 0.001). Conclusions : The use of the McGrath videolaryngoscope as the first intubation option for tracheal intubation in cardiac surgery, improves the percentage of patients with "easy" intubation", increasing glottic view and first-success rate intubation, and decreasing the incidence of moderate or difficult intubation.