Airway Management during Massive Gastric Regurgitation Using VieScope or Macintosh Laryngoscope-A Randomized, Controlled Simulation Trial

In this model of massive gastric aspiration, we compared two different laryngoscopes (VieScope and Macintosh) in a randomized, controlled simulation study. The primary endpoint was time to intubation; the secondary endpoints were intubation success (i.e., tracheal tube position) and amount of pulmonary aspiration. Thirty-four anesthetists performed endotracheal intubation using VieScope and Macintosh laryngoscopy in a randomized order on an airway manikin simulating massive regurgitation of gastric fluid. The primary endpoint "time until intubation" could be achieved significantly faster (mean -12.4 s [95% confidence intervals (CI) -19.7 s; -7.3 s]) with Macintosh compared to VieScope (p < 0.001). Concerning "correct tube position", no statistical difference was found between the devices (p = 1.0). The mean time to first ventilation was -11.1 s [95% CI -18.3 s; -5.3 s] when using Macintosh (p = 0.001). The mean volume of aspirated gastric fluid was lower in the Macintosh group: -90.0 mL [95% CI -235.0 mL; -27.5 mL] (p = 0.011). Data from this simulation study suggest that in a model of massive gastric regurgitation, airway management can be achieved faster and with less gastric aspiration when using a Macintosh laryngoscope compared to a VieScope laryngoscope.