Hypothesis: Routine use of the video laryngoscope for orotracheal intubation of patients in the ICU will increase the frequency of successful first-pass intubation compared with use of the Macintosh direct laryngoscope.
Methods: Multi-center (7 sites) RCT in France. Three-hundred and seventy-one patients were randomized to intubation with the Macintosh laryngoscope or the McGrath videolaryngoscope.
Results: Successful first-pass intubation was not different between the groups. Among intubation failures, the reason for failure in the Macintosh group was more likely to be due to inability to visualize the glottis while failure in the McGrath group was more likely to be due to inability to pass the ETT through the glottis.
Strengths: RCT, multi-center, protocolized induction, intention-to-treat and per-protocol analyses yielded similar results
Weaknesses: No stylets used on first intubation attempt (limits generalizability), post-hoc analysis of life-threatening complications, definition of severe complications
Key Point: When intubating without a stylet, use of the Macintosh or the McGrath laryngoscope yields equivalent first-pass success rates, although the reasons for failure differ between the two devices.