• Elizabeth M Marshall, Edmond O'Loughlin, and Alex D Swann.
• Department of Anaesthesia, Glasgow Royal Infirmary and Stobhill ACH, Glasgow, UK.
• Emerg Med Australas. 2014 Jun 1;26(3):262-7.

ObjectiveThe present study aims to study whether using a videolaryngoscope (A.P. Advance™) facilitates or hinders intubation by non-anaesthetists inexperienced in its use.MethodsThirty doctors from Emergency and Intensive Care Medicine backgrounds performed laryngoscopy and tracheal intubation using the Macintosh laryngoscope (MAC), A.P. Advance™ Normal Blade (AP N) and A.P. Advance™ Difficult Airway Blade (AP DAB) in simulated normal and difficult airway manikins. The primary outcomes measured were time to successful tracheal intubation and failure to intubate within 3 min or three attempts. Secondary outcomes were number of intubation attempts, adjuncts used, glottic view and ease of intubation.ResultsThere was a higher rate of failed intubation in the simulated difficult airway in participants using the AP N blade than either the MAC or AP DAB (23% vs 3% and 7%, P = 0.031). This was associated with a longer median time to intubate with the AP N and the AP DAB versus MAC (56.6, 50.2 vs 39.9 s, P = 0.007 and P = 0.041). In the normal airway median time to intubate was longest with the AP N (27.8 s), and this was significantly slower than the MAC (18.1 s, P = 0.003) and the AP DAB (17.3 s, P < 0.001). No one failed to intubate the normal manikin.ConclusionsThe use of the A.P. Advance™ videolaryngoscope should not be considered, without adequate prior training and experience, in the management of a difficult airway. The level of adequate training has yet to be established.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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