Which video laryngoscope do you have?
Video laryngoscopy in the last few years has come a long way. There have been many toys along the way and all sorts of "airway saviours" but until recently none have defined the process.
Anecdotally, the most favoured contenders include the STORZ Cmac, Gluidescope AVL (reusable) and Direct Intubation trainer (all which sit on a stand) and the King Vision, McGrath and Copilot VL which can be used in a pre-hospital setting (as well as the ED). Like most things, the different units have various pros and cons.
Review of the equipment
The STORZ equipment, whilst historically lagging somewhat on the Glidescope, set the benchmark with the Cmac. The Cmac is handheld and allows retention of direct laryngoscopy skills. The Cmac, in the opinion of the author, is superior as it does not have various plastic add-on components (ED = keep it simple).
Glidescope started with its various other iterations with disposable hand sets and introducers but, for me, in the current environment a standard handle which allows for a pretty bullet proof “best view” is always going to be my first choice. ( addendum: since first writing this page newer models are now available for Glidescope which have most of the currently desired and available features of the other brands, see below for trade link)
With the Cmac and the Glidescope (both AVL reuseable and DLT), the handles feel similar (but yes, I know, are not the same) to the standard Macintosh, you can have a look without the video so as not to “deskill” and indeed intubate as you normally would with direct laryngoscopy. If you can’t get a view simply turn around and look at the screen and there you go. Everything remains (feels) the same except your laryngoscope handle has a cable connected to a screen.
Pretty much any airway becomes a grade 1-2 view. These "toys" are intuitive to use, easy to educate new users, and have assorted blade sizes.
The Glidescope AVL disposable system is fine and works very well, it just has several components, is a different look and feel and slightly more “paint by numbers” with the potential to deskill when you work in a place that doesn’t have one.
Video Laryngoscopy is ideal in trauma (collared patients) and when used with a bougie in any airway gives you the best chance of success, other uses such as in an awake patient for removal of supraglottic FBs; spray the throat, get the patient to manipulate as far as they feel comfortable and pull out the fishbone. They do not make you an expert at making decisions so this you need to learn, watch gain experience in, and always plan to fail, use your checklist before your start and ask for help.
McGrath, Kingvision and Copilot VL have very useable devices and all championed by various users in the pre-hospital and hospital setting.
There is a review in EPmonthly which is thorough but be aware that it was probably written before the most recent model of the Glidescope.
This article studied the use of the two pre-hospitally.
This is a Youtube video which demonstrates use of the Cmac.
This is a succinct video on use, which demonstrates use of the glidescope.
From ALiEM blog a great discussion on Glidescope is available here.
Product info for glidescopes is available for both the AVL and Direct Intubation Trainer models on the trade website.
A number of VLs are discussed in Keith Greenland's airway videos which are great viewing.
Minh Le Cong does a very thorough description of the King Vision and uses this product.
Owning the Airway
This LITFL resource talks about all aspects of airway management and includes video laryngoscopy.