Comparing video and direct laryngoscopes
for pediatric intubation
Ya -Yang L iu
Received: 29 May 2017 /Accepted: 28 July 2017 / Published online: 7 August 2017
Springer-Verlag GmbH Germany 2017
To the Editor:
In a manikin study by Madziala et al.  comparing video and
direct laryngoscopes for pediatric intubation in simulated
immobilized cervical spine condition, all participants had no
prior experience with any video laryngoscope (VL) and had
minimal direct laryngoscope (DL) experience. However, they
received same training with two studied devices before the
study. The authors ignored an important issue, namely, the
different learning curves are required for two studied devices.
It has been shown that novices require about 47–56 intuba-
tions to achieve a success rate of ≥ 90% using DL . In
contrast, VL has a shorter learning curve, and novices require
only five intubations to achieve proficiency with VL .
Thus, in Madziala et al.’ study, identical training for two de-
vices would have biased both intubation time and success rate
in favor of VL, especially for difficult airway scenarios. To be
precise, the differences in performances of two studied de-
vices may be attributed to their different learning curves. It
is generally believed that for results of a comparative study to
be valid, participants must be equally proficient with each
studied device to avoid bias.
Furthermore, regarding first attempt success, another impor-
tant issue neglected by authors is that McGrath MAC is a
Macintosh-type VL. Because of using a Macintosh blade, this
device combines the benefits of DL and VL in one device. That
is, when one option at first attempt fails, intubators can immedi-
ately switch to another option to successfully complete intubation
without having to make a second attempt . This unique feature
of Macintosh-type VL is significantly different from DL and
angulated or channeled VLs, which can only provide an option.
Thus, definition of first attempt success used in this study is
suitable for DL and angulated or channeled video laryngo-
scopes, but not for Macintosh-type VL.
Authors’ Contributions Gui-Zhen Yang: This author had carefully
read the manuscript of Madziala et al, analyzed their methods and data,
suggested the comment points, and drafted this manuscript. Gui-Zhen
Yang had seen and approved the final manuscript.
Fu-Shan Xue: This author had carefully read the manuscript of
Madziala et al, analyzed their methods and data, revised comment points
and this manuscript and is the author responsible for this manuscript. Fu-
Shan Xue had seen and approved the final manuscript.
Hui-Xian Li: This author had read the manuscript of Madziala et al,
and helped to analyze their methods and data, revise this manuscript. Hui-
Xian Li had seen and approved the final manuscript. Ya-Yang Liu:
This author had read the manuscript of Madziala et al, and helped to
analyze their methods and data, revised this manuscript. Ya-Yang Liu
had seen and approved the final manuscript.
Compliance with ethical standards The authors declare that they have
no conflict of interest.
1. Madziala M, Smereka J, Dabrowski M, Leung S, Ruetzler K,
Szarpak L (2017) A comparison of McGrath MAC® and standard
direct laryngoscopy in simulated immobilized cervical spine pediat-
ric intubation: a manikin study. Eur J Pediatr 176(6):779–786
Communicated by Patrick Van Reempts
* Fu-Shan Xue
Department of Anesthesiology, Plastic Surgery Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College,
33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144,
People’s Republic of China
Eur J Pediatr (2017) 176:1285–1286