Photo Credit: Garo Manjikian

The following is a summary of “Video-stylet vs. channeled hyperangulated videolaryngoscope: Efficacy in simulated Ludwig’s angina randomized cadaver trial,” published in the February 2024 issue of Emergency Medicine by Hung, et al.

Ludwig’s angina (LA) poses a critical threat due to its potential for airway obstruction, making effective airway management crucial. For a study, researchers sought to evaluate the comparative effectiveness of three different laryngoscopes—the Trachway video stylet (VS), Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C), and standard geometric video-laryngoscope (SGVL)—in simulated LA scenarios using cadavers.

Three fresh frozen cadavers were meticulously prepared to mimic varying degrees of airway obstruction akin to LA. Fifty-five second-year resident physicians underwent comprehensive training in airway management techniques utilizing the SGVL, VS, and HAVL-C devices. Participants were randomly assigned to perform intubations on LA-simulated cadavers using the three devices, with intubation times and success rates meticulously recorded. Additionally, participants rated the perceived difficulty of intubation using a visual analog scale (VAS) score.

The success rates for intubation within 90 seconds were 40% for SGVL, 82% for VS, and 76% for HAVL-C. Notably, VS and HAVL-C demonstrated significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7 and 95% CI of 2.0–5.7 and 1.6–4.6, P < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7–17.8 and 2.4–16.7, P < 0.001, compared to SGVL. Furthermore, there was a significant correlation between the VAS score and intubation success rate and time.

In the context of LA, VS, and HAVL-C exhibited superior efficacy over SGVL. Utilizing VS and HAVL-C can lead to enhanced intubation success rates and reduced intubation times in patients with LA.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006113