BLADESHAPE
Trial question
Is hyperangulated videolaryngoscopy superior to Macintosh videolaryngoscopy in patients with anticipated difficult tracheal intubation?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 182
182 patients (62 female, 120 male).
Inclusion criteria: adult patients scheduled to undergo elective ear, nose, and throat or oral and maxillofacial surgery, who were anticipated to have a difficult tracheal intubation.
Key exclusion criteria: age < 18 years; nasotracheal intubation or special tracheal tubes; pregnancy or lactation.
Interventions
N=91 hyperangulated videolaryngoscope (tracheal intubation facilitated by hyperangulated videolaryngoscopy [C-MAC D-BLADE™]).
N=91 Macintosh videolaryngoscope (tracheal intubation facilitated by Macintosh videolaryngoscopy [C-MAC™] with either a size 3 or 4 blade).
Primary outcome
Visualization of glottic opening
89%
54%
89.0 %
66.8 %
44.5 %
22.3 %
0.0 %
Hyperangulated
videolaryngoscope
Macintosh
videolaryngoscope
Significant
increase ▲
NNT = 2
Significant increase in visualization of glottic opening (89% vs. 54%; RR 1.65, 95% CI 0.67 to 2.63).
Secondary outcomes
Significant increase in first attempt success (97% vs. 67%; AD 30%, 95% CI 12.2 to 47.8).
Significant increase in successful first-line technique (99% vs. 87%; AD 12%, 95% CI 4.41 to 19.59).
Significant increase in first attempt success without complications (92% vs. 64%; AD 28%, 95% CI 11.39 to 44.61).
Safety outcomes
No significant difference in airway-related adverse events.
Conclusion
In adult patients scheduled to undergo elective ear, nose, and throat or oral and maxillofacial surgery, who were anticipated to have a difficult tracheal intubation, hyperangulated videolaryngoscope was superior to Macintosh videolaryngoscope with respect to visualization of glottic opening.
Reference
Vera Köhl, Viktor A Wünsch, Marie-Claire Müller et al. Hyperangulated vs. Macintosh videolaryngoscopy in adults with anticipated difficult airway management: a randomised controlled trial. Anaesthesia. 2024 May 24.
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