Orotracheal Intubation With 3D-Printed Videolaryngoscope, Commercially Available Videolaryngoscope, and Direct Laryngoscopy: Comparative Study in a Pediatric Manikin

OBJECTIVES: To compare the first attempt orotracheal intubation success rate and time to intubation using a 3D-printed videolaryngoscope (3DVL), a commercially available videolaryngoscope (VL), and direct laryngoscopy (DL) in a pediatric manikin, simulating normal airway, and difficult airway. METHODS: Randomized crossover manikin study performed at a tertiary care hospital in Brazil, with the participation of 60 medical professionals with varying levels of experience in pediatric intubation. After explanation and training, participants performed orotracheal intubation in a pediatric manikin with and without a cervical collar using 3DVL, VL, and DL for a total of 6 intubations per participant. Variables recorded included first-attempt intubation success rates, the primary outcome, as well as the time to glottic visualization, the time to successful intubation, the need for external manipulation, Cormack-Lehane grade, and the preferred device in simulated difficult and normal airway scenarios. RESULTS: There was no statistically significant difference in first-attempt success rate between 3DVL, VL, and DL for simulated normal (100%, 100%, and 100%, respectively) and difficult airways (100%, 98.3%, and 100%, respectively). For the analysis using a gamma distribution, time to intubation was significantly shorter with DL than 3DVL and VL in simulated normal and difficult airways ( P =0.0002 and 0.0104, respectively). For a subsequent analysis comparing mean differences, time to intubation was significantly shorter with DL than 3DVL in both normal and difficult airways simulations (normal: mean difference 2.66 s, 95% CI: 1.27-4.05; difficult: mean difference 1.88 s, 95% CI: 0.49-3.27). Although intubation time was also shorter with DL than VL, the differences were not statistically significant (normal: mean difference 1.29 s, 95% CI: -0.09 to 2.68; difficult: mean difference 1.22 s, 95% CI: -0.17 to 2.61). CONCLUSIONS: In a simulated pediatric setting, 3DVL demonstrated comparable success rates and time to orotracheal intubation as VL. Intubation times with DL were shorter than 3DVL, while gamma distribution analysis showed equivalent intubation times between 3DVL and VL.