Comparison of the Glidescope？ and Pentax AWS？ laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation

We compared the efficacy of these devices to the Macintosh laryngoscope when used by 25 Advanced Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Glidescope？ and the AWS？ laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan？ manikin.Both the Glidescope？ and the AWS？ performed better than the Macintosh, and demonstrate considerable promise in this context. The AWS？ had the least number of dental compressions in all three scenarios, and in the cervical spine immobilization scenario it required fewer maneuvers to optimize the view of the glottis.The Glidescope？ and AWS？ devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting.Intubation of the trachea by paramedics in the pre-hospital setting may be lifesaving in severely ill and injured patients [1-3]. However, tracheal intubation is often difficult to perform in this setting, is associated with a lower success rate. Failed tracheal intubation in this setting constitutes an important cause of morbidity, arising from direct airway trauma and the systemic complications of hypoxia [4,5]. In Ireland, Advanced Paramedics (AP's) are a subgroup of Emergency Medicine Technicians that are trained and certified as being competent in the skill of direct laryngoscopy and tracheal intubation.The recent development of a number of indirect laryngoscopes, which do not require alignment of the oral-pharyngeal-tracheal axes, may reduce the difficult of tracheal intubation in the prehospital setting. Two portable indirect laryngoscopes, which could be included in ambulance equipment inventories, are the Glidescop