A single-centre, randomised controlled pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients (MAC-V trial)

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Approximately half of patients having general anaesthesia require endotracheal intubation to allow muscle relaxation, control ventilation or protect the airway. Historically, this has been achieved mostly by direct laryngoscopy with a laryngoscope. In the last 20 years, videolaryngoscopy has been used increasingly with many anaesthetists favouring its use. The two techniques are in widespread use and anaesthetists are expected to be familiar with both. There is increasing evidence that videolaryngoscopy provides superior view of the glottic opening. However, this is a surrogate endpoint and there seems to be a poor relationship between view and intubation success with many videolaryngoscopic devices. A large, pragmatic clinical trial powered for intubation success has never been performed. Current randomised control trials comparing these methods are small, use different endpoints, and specific populations, making results less generalisable. Furthermore meta analyses comparing these devices have rarely collected data relating to harm that could be consequent to their use. We believe the most meaningful endpoint to determine the performance of these devices is first pass intubation, that is, the first attempt to intubate being successful. This single-centre study aims to compare direct larygoscopy with videolaryngoscopy using first pass intubation success as the primary endpoint. We aim to test the feasibility of a large, multicentre effectiveness trial by recruiting 100 trial participants. We aim to compare the relative harms of the different laryngoscopic techniques. The results of this trial will provide improved guidance for current airway algorithms