Solutions for Difficult Intubation

Video Laryngoscopes for Managing the Difficult Airway

Intubation involves the insertion of a sterile, plastic tube past the vocal cords and into the trachea. Emergency medical technicians, respiratory therapists, certified registered nurse anesthetist (CRNAs) and anesthesiologists routinely perform this procedure.

However, this can be anything but routine when real-world complications arise. Add trauma to the head or neck, obesity, asthma, obstruction from foreign object, swelling of the tongue, spinal cord injury, abnormal airway anatomy and secretions or blood in the oropharynx, and a simple procedure quickly becomes difficult. For unstable patients, there may be only minutes to insert the endotracheal tube and save the patient’s life. Training and proper equipment are required for a successful intubation.

Successful Intubation with Video Laryngoscopes

To assist with intubation, clinicians rely on standard laryngoscopes and traditionally had to choose between a (curved) Macintosh or (straight) Miller blade. The laryngoscope is composed of a handle that contains batteries and a blade that locks into place to provide light and visualization of the airway. There are laryngoscope handles and blades in a wide range of materials and features, including single patient use and reusable blades.

Today, hospitals are purchasing video laryngoscopes for difficult intubations. A video laryngoscope has a screen for the visualization of the upper airway, which offers an improved success rate for endotracheal intubation. Prices range from $1,000 to $5,000 for micro hand held units, and larger units range from $6,000 to $13,500.

Vendors Offering Video Laryngoscopes

Verathon Portable Video Laryngoscope, GlideScope SystemVerathon owns the portable video laryngoscope market with the popular GlideScope product line. Its GlideScope systems with reusable and single patient use blades represent the highest purchasing activity for video laryngoscopes in the current MD Buyline database. GlideScope systems use a separate monitor display connected to a video baton or blade.

Magaw Medical CoPliot VL Video Laryngoscope SystemMagaw Medical sells the CoPliot VL video laryngoscope system using single patient use sheaths with a cable connecting the handle to the display.

For the micro video laryngoscope, with a monitor on the handle, the market includes the McGrath MAC from Covidien and King Vision System from Ambu. These products offer both traditional direct laryngoscope (DL) and video laryngoscope (VL). Ambu also distributes the Pentax AWS airway scope, a microscope with a disposable blade.

Micro Video Laryngoscopes

Top vendors in the video endoscopy market, such as Olympus and Karl Storz, offer small portable options. Karl Storz sells the C-MAC monitor system that operates with the C-MAC video laryngoscopes, endoscopes and the FIVE flexible intubation video endoscopes. The C-MAC monitor offers a 7” display. The C-MAC PM is a micro system, available with a 2.4” display on a laryngoscope handle.

Olympus sells the MAF-TM Airway Mobilescope. This is a standalone portable scope with monitor, light source and battery with recording ability. This is a portable bronchoscope rather than video laryngoscope, yet it offers an alternative product for visualization during intubation.

Kathey Leibold, RRT
Kathey Leibold, RRT, Clinical Analyst — Ms. Leibold joined MD Buyline in 2002 with over 24 years of experience in respiratory care for the neonatal, pediatric, cardiac and neurocritical care patients. She is the clinical analyst for respiratory care, pulmonary diagnostics, neurodiagnostics and anesthesia delivery systems. She graduated from South Plains College with a degree in respiratory care. She is credentialed through the National Board for Respiratory Care as a registered respiratory therapist and is licensed by the Texas Department of State Health Services as a respiratory care practitioner.