MedEd Bytes

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McGRATH™ MAC video laryngoscope

The McGRATH™ MAC video laryngoscope is proven to improve first time success rate,1,2 and potentially lessen hemodynamic response to intubation3,4 when compared to the traditional direct visualization technique.

In this MedEd Bytes series, we learn about the application of the McGRATH™ MAC video laryngoscope to improve intubation success.

Byte 1: Consequences of difficult intubations

Approximately 6% of intubations are difficult intubations. These difficult intubations are associated with adverse events such as oxygen desaturation, increased risk of hypertension, unexpected ICU admission, and death.5,6

Byte 2: Predicting difficult intubation

With existing methods, the majority of difficult intubations, as many as 93% of them, are unanticipated.7

Byte 3: The EMMA trial

In the EMMA trial, the McGRATH™ MAC video laryngoscope (VL) was compared to the Macintosh direct laryngoscope (DL) for routine intubation in the operating room.2

Byte 4: De Jong et al. 2022

In this study, the percent of intubations classified as easy, defined as intubations with a Cormack and Lehane grades of I or II as well as absence of mask ventilation or rescue technique, increased from about 94.3% to 98.7% concomitant with the increased use of video laryngoscopy.8

Economic benefits of videolaryngoscopy

Given the additional costs associated with difficult intubations,9 the question arises: Can using video laryngoscopy as a first approach reduce the average hospital costs by avoiding negative outcomes associated with difficult intubations?

Byte 5: Introduction

Difficult intubations may be associated with increased cost, complications, and increased ICU and hospital length of stay.5,9

Byte 6: Mouchrite et al.

Patients with difficult intubations have a mean hospital length of stay 3.8 days longer and mean ICU stay 2 days longer than control patients.9

Byte 7: Zhang et al.

In all major diagnostic groups, video laryngoscopy was associated with a reduced likelihood of postoperative ICU admission.10

Byte 8: Thaler et al. 2021

The authors conclude that the McGRATH™ MAC VL resulted in an overall cost savings of 55% compared to the GlideScope.11


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 controlled trial. Br J Anaesth. May 2016;116(5):670–9. doi:10.1111/anae.15985.


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


Altun D, Ali A, Çamcı E, Özonur A, Seyhan T. Haemodynamic response to four different laryngoscopes. Turk J Anaesthesiol Reanim. 2018;46(6):434–440. doi:10.5152/tjar.2018.59265.


Yokose M, Mihara T, Kuwahara S, Goto T. Effect of the McGRATH MAC® video laryngoscope on hemodynamic response during tracheal intubation: a retrospective study. PLoS One. 2016;11(5):e0155566. doi:10.1371/journal.pone.0155566.


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


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


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. 2015;70(3):272–81. doi:10.1111/anae.12955.


De Jong A, Sfara T, Pouzeratte Y, et al. Videolaryngoscopy as a first-intention technique for tracheal intubation in unselected surgical patients: a before and after observational study. Br J Anaesth. 2022;129(4):624–634. doi:10.1016/j.bja.2022.05.030.


Moucharite MA, Zhang J, Giffin R. Factors and Economic Outcomes Associated with Documented Difficult Intubation in the United States. Clinicoecon Outcomes Res. 2021;13:227–239. doi:10.2147/ceor.S304037


Zhang J, Jiang W, Urdaneta F. Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting. J Comp Eff Res. Jul 2021;10(10):831–844. doi:10.2217/cer-2021-0068


Thaler A, Mohamod D, Toron A, Torjman MC. Cost Comparison of 2 Video Laryngoscopes in a Large Academic Center. Journal of Clinical Outcomes Management. 2021;28(4):174–179.