Comparison of Rigid and Articulating Video Stylets During Simulated Endotracheal Intubation With Hyperangulated Video Laryngoscopy

Background: Endotracheal tube delivery through the vocal cords can be challenging with hyperangulated video laryngoscopy due to the acute angle around the tongue and surrounding airway structures. Articulating video stylets may mitigate this issue by equipping an endotracheal tube stylet with an operator-controlled articulating end that has an additional camera at the tip.

Objectives: We compared operator-reported ease of intubation between the traditional rigid stylet (GlideRite^Ⓡ Rigid Stylet, Verathon Inc., Bothell, WA) and the articulating video stylet (ProVu™ Video Stylet, Flexicare Inc., Irvine, CA) with a hyperangulated video laryngoscope (GlideScope^Ⓡ, Verathon Inc., Bothell, WA).

Methods: Participants performed simulated intubation using a hyperangulated video laryngoscope with both stylets in random order. We compared operator-reported ease of intubation on a 0-100 visual analogue scale (VAS), best percentage of glottic opening (POGO), and time to intubation. We compared outcomes using a paired t-test or the asymptotic Wilcoxon-Pratt signed-rank test dependent on normality.

Results: We enrolled a convenience sample of 16 emergency department attendings, residents, and physician assistant postgraduate trainees. The median operator-reported ease of intubation on VAS was 20 (interquartile range 9, 30) for the rigid stylet and 20 (10, 30) for the articulating video stylet (p = 0.832). However, the rigid stylet had a slightly shorter mean time to intubation compared with the articulating video stylet, 6.9 (standard deviation 2.5) vs. 10.3 (4.1) s, respectively (p = 0.017). POGO was similar between groups.

Conclusions: During simulated endotracheal intubation, the rigid and articulating video stylets had similar operator-reported ease of intubation.