Improve First-attempt Intubation Success with the McGRATH™ MAC Video Laryngoscope

Can the right video laryngoscope help improve first-pass success rate? Multiple intubations attempts can often lead to dire consequences for your patients, including hypoxia and cardiac arrest. 3 A recent trial shows that the  McGRATH™ MAC video laryngoscope can help you improve first-attempt intubation success compared direct laryngoscopy — helping you keep patients safe.

Difficult intubations often happen without warning

Difficult intubations, an intubation that requires multiple attempts before success is achieved, occur in approximately 6% of intubations.4 Difficult intubations are associated with adverse events such as oxygen desaturation, increased risk of hypertension, dental damage, airway damage, unexpected ICU admission and sequelae of hypoxia such cardiac arrest, brain damage and death.3 With each intubation attempt, the likelihood of a major adverse event increases.5 In a publication in JAMA in 2021, Russotto et al found that among critically ill patients who required endotracheal intubation, the rate of major adverse peri-intubation events increased from 43.2% in the population intubated after the first attempt to 51.5% after two attempts and 58% after three or more attempts.5 Because repeated intubation attempts are associated with complications, maximizing the probability of successful intubation on the first attempt is an important goal to optimize patient safety. Because repeated intubation attempts are associated with complications, maximizing the probability of successful intubation on the first attempt is an important goal to optimize patient safety.

Preoperative evaluation of the airway is routinely performed in order to identify difficult airways. However, a recent study of 188,064 intubation attempts found that 93 percent of difficult intubations were unanticipated. 2 Nearly 50 percent of airway-related adverse events occur in patients who are categorized as routine, with an ASA I or II rating. 6 Furthermore, tests for predicting difficult intubations often perform poorly. A meta-analysis of studies evaluating the predictive value of tests for difficult airways revealed surprisingly low sensitivity of these tests.

As the consequences of difficult intubations can be significant, clinicians should consider techniques that facilitate a high likelihood of first-pass intubation success. Compared to direct laryngoscopy, the McGRATH™ MAC video laryngoscope helps clinicians improve first pass success rate.1, 8

Related: Learn more about video laryngoscopy and first attempt intubation success.

Improve first-pass intubation success with routine use of McGRATH™ MAC video laryngoscopy

The EMMA (Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation (NCT02611986)) trial was performed across eight divisions in two hospitals. 1 The study was published in the journal Anaesthesia in 2023.

This study evaluated if the use of the McGRATH™ MAC video laryngoscope (VL) compared with a direct laryngoscope (DL) improves first-pass tracheal intubation success in patients having elective surgery. A total of 2,092 patients were analyzed from 2015-2019. Patients were randomized to receive McGRATH™ MAC VL (n=1,053) or direct laryngoscopy (n=1039).

The primary outcome measure was the number of patients successfully intubated during the first attempt. Secondary endpoints included: 

  • overall success rate of tracheal intubation (first and second attempts)
  • time to view (insertion of the device until glottic view)
  • time to tracheal tube placement (insertion of the device to tracheal tube passing through the vocal cords) 
  • time to ventilate (insertion of the device to first end-tidal capnography waveform) 
  • failures/crossovers to other rescue techniques 
  • use of extra laryngeal manipulation 
  • glottic view using Cormack and Lehane grading; percentage of glottic opening score 
  • tracheal intubation difficulty score 
  • and complications (e.g. desaturation < 90%; dental or soft tissue trauma) 

The study found significantly higher first-pass intubation success rate using the McGRATH™ MAC VL (94%) compared with DL (82%) (p<0.001). Subgroup user analysis found that the McGRATH™ MAC group had improved first-pass success rate among experience consultants (95.7%, 90.3%) and trainees (92.6%, 77.1%). Furthermore, the McGRATH™ MAC group had improved overall intubation success (first and second attempts) (99%, 96%), better glottic view, and fewer reported intubation difficulty scores >5 compared with DL.

For trained personnel only. For specific indications and instructions for use, please refer to the product manual

Discover the benefits of the McGRATH™ MAC video laryngoscope today.


1. Kriege M, Noppens RR, Turkstra T, et al. A multicentre randomised controlled trial of the McGrath™ Mac videolaryngoscope versus conventional laryngoscopy. Anaesthesia. Jun 2023;78(6):722- 729. doi:10.1111/anae.15985

2. Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. Mar 2015;70(3):272-81. doi:10.1111/anae.12955

3. Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth. Dec 2012;109 Suppl 1:i68-i85. doi:10.1093/bja/aes393

4. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. Aug 2005;103(2):429- 37. doi:10.1097/00000542-200508000-00027

5. Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. Jama. Mar 23 2021;325(12):1164-1172. doi:10.1001/jama.2021.1727

6. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. May 2011;106(5):617-31. doi:10.1093/bja/aer058

7. Roth D, Pace NL, Lee A, et al. Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review. Anaesthesia. Jul 2019;74(7):915-928. doi:10.1111/anae.14608

8. Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized 

About the Author

Scott Stoneburner is a Principle Medical Affairs Specialist who focuses on disseminating evidence-based information for Medtronic’s Respiratory and Monitoring Solutions franchise.

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