A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry.

In this retrospective, observational study, Peyton et al have compared a variety of standard video blades (e.g. C-Mac and Mac Miller) to non-standard, hyperangulated video blades (e.g. C-MAC D blade, Glidescope) in patients expected or known to have difficult or impossible direct laryngoscopy. The data was obtained from PeDI-R, a collaborative, multicentre, international registry and analysed for initial success, eventual success, complications and technical difficulties.

Success rates of initial intubation in patients ≥ 5kg did not differ between standard and non-standard blades.  However, initial intubation success in patients < 5kg was significantly higher with standard than with non-standard blades (51% vs 26% p=0.002).  Eventual tracheal intubation success rate was also higher with standard than with non-standard blades. While it was more likely to achieve a 2a view or better using non-standard blades, standard blades had a lower rate of technical difficulties with tube insertion. In the crossover group of 44 patients, after failed videolaryngoscopy with any blade, rescue attempts were more successful with non-standard compared with standard blades (61% vs 14% p<0.001)


Choice of videoscope in the difficult paediatric airway is determined by a multitude of factors including clinician choice, level of comfort with equipment, department availability, and whether it is being used as a teaching tool. Whilst choice of blade had little impact on the success of tracheal intubation in the larger child, the overall initial success rates of just 62% may reflect other factors that could be optimised prior to intubation. In children < 5kg, standard videoscope blades should probably be the first choice. And when difficulties or failure with standard videolaryngoscopy occurs, hyperangulated blades increase the chance of success.

Reviewed by Dr. Aylin Seven