Video laryngoscopes

[lymphocyte]

I'm trying to buy relatively cheap/durable video laryngoscopes for some very small rural EDs. The users would be infrequent intubators who have reasonable but novice airway experience. It would be nice to have something like the Karl Storz C-MAC Pocket Monitor, for example, but it's just not feasible financially. So far, I've looked at the iView, McGrath Mac, AirTraq, Glide Scope and Ambu King Vision. Any recommendations, thoughts, or experiences? I would appreciate any help.

(I've already got them stocked with some great LMA's, airway adjuncts, etc.)

---

Members don't see this ad.

 

[BoardingDoc]

I'm trying to buy relatively cheap/durable video laryngoscopes for some very small rural EDs. The users would be infrequent intubators who have reasonable but novice airway experience. It would be nice to have something like the Karl Storz C-MAC Pocket Monitor, for example, but it's just not feasible financially. So far, I've looked at the iView, McGrath Mac, AirTraq, Glide Scope and Ambu King Vision. Any recommendations, thoughts, or experiences? I would appreciate any help.

(I've already got them stocked with some great LMA's, airway adjuncts, etc.)

I've used the McGrath and the glide scope quite a bit. The former is nice because you can use it as a normal DL, but also get solid video views. That said, I personally prefer the glide scope. It's what I use for essentially 100% of my first pass attempts. The angle makes things stupid easy and the video quality is quite good. If you decide to get a glide, some tips:

1: Slide the ETT alongside the glidescope blade. Watch the tube, NOT THE SCREEN, until the tube is in their mouth and running alongside the glidescope blade. Novices can wind up cheeking the tube if they stay glued to the screen and don't watch where they're inserting the tube.

2: The glidescope blade is plastic. That's ok. Once you're in the vallecula, don't be afraid to pull up on their jaw with it to get a better view of the cords. It'll hold.

3: The angle of the rigid stylette can occasionally make the tube get stuck on/just past the cords. If you are basically in but having a hard time passing, have someone pull the stylette back by 1-2cm --> keep advancing so you're solidly through cords --> pull stylette completely --> balloon up, blade out, Bob's your uncle.

 

[southerndoc]

My firefighters use the McGrath. It's a great blade.

Like @BoardingDoc I also like the Glidescope. There's a trick to getting the tube to advance. When you're just entering the trachea, you hold hte tube in such a way that you basically curl all your fingers around the top of it and then use your thumb to hold the stylette in place while using your hand/fingers to advance the ET tube. It's something that takes practice, but you should be able to do it by yourself with this method.

For Pete's sake, never ever bend the Glidescope stylette. It's curved at the correct angle to mirror the Glidescope. Bend it, and you might as well get a new stylette.

 

[Angry Birds]

King vision VL
I’d become their spokesman if I could. It’s the best

 

[dadaddadaBATMAN]

I've used the McGrath and the glide scope quite a bit. The former is nice because you can use it as a normal DL, but also get solid video views. That said, I personally prefer the glide scope. It's what I use for essentially 100% of my first pass attempts. The angle makes things stupid easy and the video quality is quite good. If you decide to get a glide, some tips:

1: Slide the ETT alongside the glidescope blade. Watch the tube, NOT THE SCREEN, until the tube is in their mouth and running alongside the glidescope blade. Novices can wind up cheeking the tube if they stay glued to the screen and don't watch where they're inserting the tube.

2: The glidescope blade is plastic. That's ok. Once you're in the vallecula, don't be afraid to pull up on their jaw with it to get a better view of the cords. It'll hold.

3: The angle of the rigid stylette can occasionally make the tube get stuck on/just past the cords. If you are basically in but having a hard time passing, have someone pull the stylette back by 1-2cm --> keep advancing so you're solidly through cords --> pull stylette completely --> balloon up, blade out, Bob's your uncle.

If they were previously doing direct Personally would vote for McGrath. It’s very similar with a great view anteriorly and no special modification really needed

I’ve seen too many people panic with a glide scope after sticking it in too far. Universally they have a great view of the cords and the tube “just won’t pass” and keeps diving below the cords because the scope itself is in the way.

It’s counterintuitive for an inexperienced user to pull the scope back a bit to allow passage

For the stylet I always prepare two. One is the premade stylet, the other is a malleable stylet that I mold almost identical to the premade so I can swap out if I need to bend the tip a little more anterior or whatever. And a bougie

 

[Angry Birds]

If they were previously doing direct Personally would vote for McGrath. It’s very similar with a great view anteriorly and no special modification really needed

I’ve seen too many people panic with a glide scope after sticking it in too far. Universally they have a great view of the cords and the tube “just won’t pass” and keeps diving below the cords because the scope itself is in the way.

It’s counterintuitive for an inexperienced user to pull the scope back a bit to allow passage

For the stylet I always prepare two. One is the premade stylet, the other is a malleable stylet that I mold almost identical to the premade so I can swap out if I need to bend the tip a little more anterior or whatever. And a bougie

This is why the channeled blade of the King Vision VL is the solution. Great view. Channeled blade so passing the tube is easy. One handed operation.

But wait, there’s more…!

 

[Rekt]

My firefighters use the McGrath. It's a great blade.

Like @BoardingDoc I also like the Glidescope. There's a trick to getting the tube to advance. When you're just entering the trachea, you hold hte tube in such a way that you basically curl all your fingers around the top of it and then use your thumb to hold the stylette in place while using your hand/fingers to advance the ET tube. It's something that takes practice, but you should be able to do it by yourself with this method.

For Pete's sake, never ever bend the Glidescope stylette. It's curved at the correct angle to mirror the Glidescope. Bend it, and you might as well get a new stylette.

Depends on your model. The new glideacope has the "normal" hyperangulated blade that you're only supposed to use rigid stylettes for but also has exact plastic replicas of a normal DL MAC. You can tube DL with it even if you wanted then just look at screen if youre lost or good for teaching interns to DL so you can see what they see. I almost exclusively use flexible stylettes when I use VL. I'll have hyperangulated blade and rigid as a backup if needed plus bougie etc.

 

[turkeyjerky]

Personally, I've never liked the small handheld devices. I know some people swear by them, but I've always felt that's more of a 'look at my shiny new toy' thing rather than the actual performance.

 

[GassYous]

Personally, I've never liked the small handheld devices. I know some people swear by them, but I've always felt that's more of a 'look at my shiny new toy' thing rather than the actual performance.

Mcgrath is the real thing. I use it almost exclusively. DL once in a while to keep my skills up, mostly in the edentulous.

 

[Robotic Wis-Hipple]

Mcgrath is the real thing. I use it almost exclusively. DL once in a while to keep my skills up, mostly in the edentulous.

I’m teasing you here, but if your keeping your skills up DL’s are on the edentulous I’m not sure it’s doing what you think it’s doing.

You can pretty much skip the rest of an airway exam if there’s no teeth…..

 

[Rekt]

I’m teasing you here, but if your keeping your skills up DL’s are on the edentulous I’m not sure it’s doing what you think it’s doing.

You can pretty much skip the rest of an airway exam if there’s no teeth…..

"Airway exam". Lol.

 

[Groove]

I'm trying to buy relatively cheap/durable video laryngoscopes for some very small rural EDs. The users would be infrequent intubators who have reasonable but novice airway experience. It would be nice to have something like the Karl Storz C-MAC Pocket Monitor, for example, but it's just not feasible financially. So far, I've looked at the iView, McGrath Mac, AirTraq, Glide Scope and Ambu King Vision. Any recommendations, thoughts, or experiences? I would appreciate any help.

(I've already got them stocked with some great LMA's, airway adjuncts, etc.)

McGrath. It's damn near perfect and so portable. I bought one of my own for locums and then talked one of our community EDs into purchasing one for the dept. I have to respond to floor codes in that hospital and can't think of a better blade to grab when running to a floor code or ICU code, etc.. Lots of different blade sizes. Get this pelican case for it. You can shove several different sized blades into it, grab it and run.

1170 McGrath Laryngoscope Case | Medical Cases | The Case Store

1170 McGrath Pelican Case is designed for a laryngoscope and accessories. This Pelican case has shock-absorbing foam. Order yours today!

www.thecasestore.com

 

[clibby]

I love having the Glidescope with the Mac blade in case I need to switch to DL. The bigger screen away from the patient's mouth is the best for me. However, it isn't really as portable as the McGrath if you are running to floor codes. I really like the portability and ease of use of the McGrath and if intubating outside the department too, I would prefer the McGrath. I used the King Vision in residency and never really liked it. It was kind of clunky having to swap out the blade sizes then the disposable. The McGrath was just easier to use with less pieces to keep track of.

 

[GassYous]

I’m teasing you here, but if your keeping your skills up DL’s are on the edentulous I’m not sure it’s doing what you think it’s doing.

You can pretty much skip the rest of an airway exam if there’s no teeth…..

I feel you man. But I'm just practicing the feel and the view. I've probably done thousands in residency. I switched because I had a fatty desat on me with a mac 3 in an outpatient center when I struggled to get a view. I heard a click as I was getting the tube in and I got super worried about a chipped tooth. The reusable metal blades are bigger than the disposable ones I used in residency and I hate them.

 

[lymphocyte]

McGrath. It's damn near perfect and so portable. I bought one of my own for locums and then talked one of our community EDs into purchasing one for the dept. I have to respond to floor codes in that hospital and can't think of a better blade to grab when running to a floor code or ICU code, etc.. Lots of different blade sizes. Get this pelican case for it. You can shove several different sized blades into it, grab it and run.

1170 McGrath Laryngoscope Case | Medical Cases | The Case Store

1170 McGrath Pelican Case is designed for a laryngoscope and accessories. This Pelican case has shock-absorbing foam. Order yours today!

www.thecasestore.com

Just to be clear, is this what you mean? Seems to be the resounding favourite in this thread.

For everybody else, I appreciate the Glidescope but it can be fiddly and needs extra training.

McGRATH™ MAC Video Laryngoscope | Medtronic (NZ)

The McGRATH™ MAC video laryngoscope combines the benefits of both direct and video laryngoscopy in a single, affordable handheld device.

www.medtronic.com

 

[bravotwozero]

McGrath is awesome, I’d vouch for it. Very portable and great view.

 

[lymphocyte]

Apparently McGrath is just coming out with a brand new model. Very affordable too. Looks like it's the winner. I'll let everybody know how it goes. Thank you.

 

[FiremedicMike]

Not a doc, obviously, but I set up testing and eval at my department to replace our aging king vision visions with the McGrath, including field testing and cadaver lab.

The biggest advantage to the McGrath is that it feels and is shaped like a traditional laryngoscope and if your camera becomes blocked you can seamlessly transition and use it as a traditional laryngoscope.

The biggest complaint I hear about it is the video resolution is poor, much worse than the king vision. From my perspective, I’m not trying to watch a basketball game, and I can see the cords just fine in it, but that is what our guys complain about.

We did use the king vision for many years, and it’s a fine tool, its only downfall is it doesn’t always fit in their mouth..

 

[Groove]

Just to be clear, is this what you mean? Seems to be the resounding favourite in this thread.

For everybody else, I appreciate the Glidescope but it can be fiddly and needs extra training.

McGRATH™ MAC Video Laryngoscope | Medtronic (NZ)

The McGRATH™ MAC video laryngoscope combines the benefits of both direct and video laryngoscopy in a single, affordable handheld device.

www.medtronic.com

That's the one. The only negative I can think to say about it is the fact that the portable batteries are proprietary and if memory serves...about $50-60 per battery pack which gives you...I think 200+ hours (per battery). It's a minor quibble. I'd recommend seeing if your local Medtronic rep can give you a discount and throwing in a few extra batteries. There's a huge markup on these things. I paid MSRP on my first personal one and then it got stolen at work (or thrown away...who knows) and the rep got me a replacement for 1K which was about half of what I originally paid for it. It's a smaller screen compared to a glidescope but totally adequate. My intensivist at one of our community sites loves it and had the ICU buy their own.

 

[FiremedicMike]

That's the one. The only negative I can think to say about it is the fact that the portable batteries are proprietary and if memory serves...about $50-60 per battery back which gives you...I think 200+ hours (per battery). It's a minor quibble. I'd recommend seeing if your local Medtronic rep can give you a discount and throwing in a few extra batteries. There's a huge markup on these things. I paid MSRP on my first personal one and then it got stolen at work (or thrown away...who knows) and the rep got me a replacement for 1K which was about half of what I originally paid for it. It's a smaller screen compared to a glidescope but totally adequate. My intensivist at one of our community sites loves it and had the ICU buy their own.

Building off this, our rep gave us some loaners that we were allowed to use in the field on live patients to help us decide before we bought. Not sure if that's just an EMS thing or just a thing with my sales rep, but it might be worth a call.

And you're right, the batteries are $56/ea, they last for 200 cycles +/-

 

[DrOwnage]

its only downfall is it doesn’t always fit in their mouth.

No one? ok.

 

[Angry Birds]

Not a doc, obviously, but I set up testing and eval at my department to replace our aging king vision visions with the McGrath, including field testing and cadaver lab.

The biggest advantage to the McGrath is that it feels and is shaped like a traditional laryngoscope and if your camera becomes blocked you can seamlessly transition and use it as a traditional laryngoscope.

The biggest complaint I hear about it is the video resolution is poor, much worse than the king vision. From my perspective, I’m not trying to watch a basketball game, and I can see the cords just fine in it, but that is what our guys complain about.

We did use the king vision for many years, and it’s a fine tool, its only downfall is it doesn’t always fit in their mouth..

I haven’t had any problem fitting the King Vision in any one’s mouth. But maybe you’re talking about pediatric patients?

Also, does the McGrath have a channeled blade? That’s the huge upside of the king vision in my view because the hardest part about VL is that you get a good view but can’t pass the tube.

Forgive typos. Typing from phone

 

[FiremedicMike]

I haven’t had any problem fitting the King Vision in any one’s mouth. But maybe you’re talking about pediatric patients?

Also, does the McGrath have a channeled blade? That’s the huge upside of the king vision in my view because the hardest part about VL is that you get a good view but can’t pass the tube.

Forgive typos. Typing from phone

We had sporadic issues with adult mouths not opening wide enough for the channeled blade. Manipulation of everything involved usually overcame it, but it was a frustration point during the intubation for sure. I wouldn’t call it a widespread issue, but it happened from time to time.

No channeled blade with the McGrath, but we start with the bougie at first attempt and haven’t had any issues.

I found the McGrath just puts everything right where it needs to be. I was pleasantly surprised by this and haven’t missed the channeled blade.

One other note, some of the posts here are mentioning personal ownership. The McGrath blades are significantly cheaper to replace than the king vision blades..

 

[GassYous]

I haven’t had any problem fitting the King Vision in any one’s mouth. But maybe you’re talking about pediatric patients?

Also, does the McGrath have a channeled blade? That’s the huge upside of the king vision in my view because the hardest part about VL is that you get a good view but can’t pass the tube.

Forgive typos. Typing from phone

No but you don't need it. I hate the channel. I don't even stylet the tube for mcgrath for 90% of tubes. Sometimes need it for the fatties with big tongues or anterior airways but usually can get away with folding the tube

Mcgrath will sometimes give you the scope for free and make money on the blades.

 

[Apollyon]

Mcgrath will sometimes give you the scope for free and make money on the blades.

The Gillette razors model!

 

[Cinclus]

I tube with McGrath pretty much exclusively these days. Works well. Can DL and have the video right there.

 

[deleted1077312]

We have McGraths on the ambulance; no complaints

 

[coffeebythelake]

I'm trying to buy relatively cheap/durable video laryngoscopes for some very small rural EDs. The users would be infrequent intubators who have reasonable but novice airway experience. It would be nice to have something like the Karl Storz C-MAC Pocket Monitor, for example, but it's just not feasible financially. So far, I've looked at the iView, McGrath Mac, AirTraq, Glide Scope and Ambu King Vision. Any recommendations, thoughts, or experiences? I would appreciate any help.

(I've already got them stocked with some great LMA's, airway adjuncts, etc.)

Used many different types of VL including CMAC, Mcgrath, kingvision, imo Glidescope is the best. Wide view, so you can see the tube come in from the side, rarely blocks view during the critical period when tube is passing through the glottic opening.

 

[Arch Guillotti]

Used many different types of VL including CMAC, Mcgrath, kingvision, imo Glidescope is the best. Wide view, so you can see the tube come in from the side, rarely blocks view during the critical period when tube is passing through the glottic opening.

Glidescope is superior, the only quibble I have is that the stylette is preformed and not malleable which makes those “anterior” airways a pain sometimes.

 

[coffeebythelake]

Glidescope is superior, the only quibble I have is that the stylette is preformed and not malleable which makes those “anterior” airways a pain sometimes.

I load the stylet backwards to the shape of the ett, so when I pull it back slightly the ett tip becomes less anterior.

 

[Fox800]

I trained with C-MAC, Mac 3 or 4 blade + bougie for every intubation. Worked very well and you remain facile with your DL skills. Transitioning to Glidescope is OK but awkward. I always have to coach the RT to hold the stylet handle still while I advance the tube, otherwise they withdraw it immediately before the tube is in place. Whatevs. I miss my C-MACs

 

[lymphocyte]

To close the loop on this thread, I got the Medtronic Mcrath Mac with the mixed blade kit including the X blades.

It's really good. Portable. Lightweight. Well-constructed. Intuitive. Very good for infrequent intubators. Medtronic have been easy to work with too.

Not ideal for field intubations because of screen glare. I needed a drape for one because it was so damn sunny.

Batteries are expensive and single use, but still much cheaper than getting a Karl Storz.

X blades are worthless if you're not comfortable with hyperangulated blades. Might as well just get a Glidescope.

Overall, I love it. All the departments we sent it to love it.

Thank you so much to everyone who responded. If anybody ever needs notes comparing these devices, I'm always happy to answer a PM.