Comparison of the Airtraq？ and Truview？ laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins

We compared the efficacy of these devices to the Macintosh laryngoscope when used by 21 Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Airtraq？ and Truview？ 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.The Airtraq？ reduced the number of optimization manoeuvres and reduced the potential for dental trauma when compared to the Macintosh, in both the normal and simulated difficult intubation scenarios. In contrast, the Truview？ increased the duration of intubation attempts, and required a greater number of optimization manoeuvres, compared to both the Macintosh and Airtraq？ devices.The Airtraq？ laryngoscope performed more favourably than the Macintosh and Truview？ devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting.Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. While intubation of the trachea in the prehospital setting can be a life-saving manoeuvre [1-3], direct laryngoscopy in this setting, such as in a multiple trauma patient, is potentially difficult. Failed tracheal intubation in this context 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. Following training on high fidelity manikins, each AP is then seconded to a hospital for clinical training in the operating suite. Each AP must perform a minimum of 10 successful tracheal intubations under the direct supervisi