• Matthieu Amalric, Romaric Larcher, Vincent Brunot, Fanny Garnier, Audrey De Jong, Valerie Moulaire Rigollet, Philippe Corne, Kada Klouche, and Boris Jung.
• Medical Intensive Care Unit, Montpellier University and Montpellier University Health Care Center, Montpellier, France.
• Crit. Care Med. 2020 Oct 1; 48 (10): e889-e896.

ObjectivesThe use of a videolaryngoscope in the ICU on the first endotracheal intubation attempt and intubation-related complications is controversial. The objective of this study was to evaluate the first intubation attempt success rate in the ICU with the McGrath MAC videolaryngoscope (Medtronic, Minneapolis, MN) according to the operators' videolaryngoscope expertise and to describe its association with the occurrence of intubation-related complications.DesignObservational study.SettingMedical ICU.SubjectsConsecutive endotracheal intubations in critically ill patients.InterventionsSystematic use of the videolaryngoscope.Measurements And Main OutcomesWe enrolled 202 consecutive endotracheal intubations. Overall first-attempt success rate was 126 of 202 (62%). Comorbidities, junior operator, cardiac arrest upon admission, and coma were associated with a lower first-attempt success rate. The first-attempt success rate was less than 50% in novice operators (1-5 previous experiences with videolaryngoscope, independently of airway expertise with direct laryngoscopies) and 87% in expert operators (> 15 previous experiences with videolaryngoscope). Multivariate analysis confirmed the association between specific skill training with videolaryngoscope and the first-attempt success rate. Severe hypoxemia and overall immediate intubation-related complications occurred more frequently in first-attempt failure intubations (24/76, 32%) than in first-attempt success intubations (14/126, 11%) (p < 0.001).ConclusionsWe report for the first time in the critically ill that specific videolaryngoscopy skill training, assessed by the number of previous videolaryngoscopies performed, is an independent factor of first-attempt intubation success. Furthermore, we observed that specific skill training with the McGrath MAC videolaryngoscope was fast. Therefore, future trials evaluating videolaryngoscopy in ICUs should consider the specific skill training of operators in videolaryngoscopy.

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