Some of the best things in medicine have been discovered by accident 鈥� penicillin, x-rays and the pacemaker are a few.
PennSTAR 鈥� the nonprofit critical care transport program operated by Philadelphia-based Penn Medicine 鈥� didn鈥檛 invent its preferred laryngoscopy device, but it did find it unexpectedly.
鈥淭丑别 video laryngoscope kind of fell into our laps,鈥� recalled Thomas Levins, a veteran ground and flight paramedic and nurse who served as the program鈥檚 clinical coordinator when it was implemented and still runs calls with both PennSTAR and Inspira Health EMS in New Jersey.
鈥淏ack when video laryngoscopy first started, we looked at several different devices. Some were great products but extremely expensive. Some just weren鈥檛 for us. Our trauma program manager had a connection with and got us a couple of the McGRATHs as a demo, and we liked them. It wasn鈥檛 as pricey as the other devices out there, and it also worked in just about every age group. The smallest patient it was used on was a 3-year-old who required RSI. The McGRATH provides a great combination of cost and functionality.鈥�
As video laryngoscopy advances toward being the standard of care in EMS, that blend brings a lot of benefits.
Moving to video first
Offered by for a decade now, the video laryngoscope adds line-of-sight portrait-view video to the traditional curved-blade Macintosh approach. Compared to direct laryngoscopy, video laryngoscopy improves first-pass success and reduces time to intubation.1鈥�4 It鈥檚 also suitable for nearly everyone.
鈥淰ideo, for the most part, works great in every patient except the patient with the very soiled airway,鈥� said Levins. 鈥淔or patients with facial trauma, blood or vomit, the video aperture can be occluded, and you can lose vision. So just for that reason, I don鈥檛 want to lose the ability to do direct laryngoscopy.鈥�
Direct laryngoscopy is a useful skill to retain, and PennSTAR helps its providers preserve it by not mandating a video-first approach. The service has, however, seen most providers embrace video. 鈥淚 do find, at both of my jobs, crews 鈥� even old folks like me 鈥� are moving to video first, just because it maximizes first-pass success,鈥� Levins added.
PennSTAR put McGRATH MAC video laryngoscopes on all its aircraft and ground trucks, where they came into broad use quickly. They鈥檝e been effective, though crews do fewer field intubations these days. As a ground service with access to RSI, Inspira does more, and it moved to the McGRATH as well.
鈥淚 get significantly more intubations working as a ground provider for Inspira than I do working for PennSTAR,鈥� said Levins. 鈥淭丑别y have a lot more opportunity, having several MICUs throughout South Jersey, to perform more intubations. A lot of the crews there have moved to using video as well, and the McGRATH is their primary mechanism.鈥�
Difficult intubations, , can contribute to longer hospital stays and increase costs by thousands of dollars versus nondifficult intubations, and video laryngoscopy produces lower intubation difficulty scores. The McGRATH MAC video laryngoscope specifically produced favorable results in a 2023 comparison against direct laryngoscopy led by German physician Marc Kriege.1 In that multicenter randomized trial involving more than 2,000 patients, first-pass tracheal intubation success was higher with the McGRATH (94% vs. 82%), with an absolute risk reduction of more than 12%.
Find an overview of that first-pass advantage and other literature findings here.
Providers benefit, Levins notes, from familiarity with its curved-blade technique 鈥� they don鈥檛 have to worry about additional laryngoscopy approaches and mastering extra skills. No additional training was needed for PennSTAR providers, whose feedback on the device was enthusiastic.
鈥淭丑别 McGRATH is basically curved-blade laryngoscopy with video, so you鈥檙e not really learning a secondary skill,鈥� Levins said. 鈥淥ther devices can require completely different skills that you have to train on. With muscle memory, the McGRATH is just easier. You don鈥檛 have to think, 鈥極h, wait 鈥� I鈥檓 using this, so I have to do this.鈥� It is just basically laryngoscopy, and there鈥檚 a little video camera there that makes your job easier.鈥�
The McGRATH MAC video laryngoscope is ergonomically designed with light weight, enhanced optics, increased durability and intelligent battery management that includes a minute-by-minute indicator and automatic shutoff feature to preserve battery life. The upright provider position allowed by video laryngoscopy is also recommended to reduce exposure to droplets and pathogens. The McGRATH MAC features five blade size options for patients of all sizes, as well as a hyperangulated for difficult airways. That鈥檚 been shown to produce grade 1 or 2 Cormack-Lehane views in 97% of uses.
Protection against misadventure
At PennSTAR, adopting the video laryngoscope contributed to overall first-pass success rates in the realm of 90% plus. Now a younger generation of providers raised on video technology is helping enshrine those benefits and establish video laryngoscopy as an EMS standard of care.
鈥淲hen I started as a paramedic, there was no video in the ER and certainly no prehospital video,鈥� said Levins. 鈥淣ow I wouldn鈥檛 want to have an airway misadventure and not have video available, because you鈥檇 leave yourself open to significant litigation. It鈥檚 the standard of care 鈥� you have to have something available. The McGRATH is a great choice for many EMS agencies because it鈥檚 functional and cost-effective.鈥�
References
- 鈥淎 multicentre randomized controlled trial of the McGRATH MAC videolaryngoscope versus conventional laryngoscopy.鈥� Marc Kriege, Ruediger R. Noppens, Tim Turkstra, et al. Anaesthesia. 2023. https://pubmed.ncbi.nlm.nih.gov/36928625/
- 鈥淐ost comparison of 2 video laryngoscopes in a large academic center.鈥� Andrew Toron. Journal of Clinical Outcomes Management. 2021. www.academia.edu/80624833/Cost_Comparison_of_2_Video_Laryngoscopes_in_a_Large_Academic_Center
- 鈥淎doption of video laryngoscopy by a major academic anesthesia department.鈥� Jon D. Samuels, Virginia E. Tangel, Briana Lui, et al. Journal of Comparative Effectiveness Research. 2021. https://pubmed.ncbi.nlm.nih.gov/33470849/
- 鈥淩andomized controlled trial comparing the McGRATH MAC video laryngoscope with the King Vision video laryngoscope in adult patients.鈥� Bret D. Alvis, Douglas Hester, Dusty Watson, et al. Minerva Anestesiologica. 2016. www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2016N01A0030#
McGRATH MAC is a registered trademark of Medtronic.
