Initial Laryngoscope Blade Selection and Outcomes in Paediatric Emergency Department Intubations: Miller vs. Macintosh.

چکیده اصلی

BACKGROUND: Optimal initial laryngoscope blade selection for paediatric emergency intubation is uncertain. We examined whether Miller or Macintosh blades are associated with differences in first-pass success (FPS) and adverse events in children < 5 years. METHODS: Prospectively collected data from the Australia and New Zealand ED Airway Registry (ANZEDAR) between March 2010 and March 2024 were analysed for children under 5 years of age. We report demographics, FPS and adverse events by initial blade type. Multivariable models examined factors associated with FPS and hypoxia. RESULTS: Among 201 children, 88 (43.8%) were intubated with a Miller blade and 113 (56.2%) with a Macintosh blade. In unadjusted analyses, children intubated with Miller blades were younger (median 0.4 years, IQR 0.08-1.35 vs. median 1.6 years, IQR 0.75-2.00), p < 0.001), had lower FPS (63.6% vs. 80.5%; OR 0.42, 95% CI 0.22-0.80; p = 0.008) and had a higher incidence of hypoxia (33.0% vs. 17.7%; OR 2.28, 95% CI 1.19-4.46; p = 0.01) compared with children intubated with Macintosh blades. Hypotension rates did not differ. CONCLUSION: In this cohort of young children intubated in the ED, Macintosh blade use was associated with higher FPS and fewer hypoxic events compared with Miller blade. Age was a significant confounder and should be considered when choosing which laryngoscope blade to use in young children.

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