Comparison of intubation techniques using standard geometric videolaryngoscope with bougie, hyperangulated videolaryngoscope, and videostylet in cadavers with only epiglottis visible.

Cormack-Lehane grade 3 airways, where only the epiglottis is visible, present significant challenges due to limited operator experience and poor patient positioning, with little evidence on the best videolaryngoscopy approach. This study evaluated the effectiveness of two emerging devices-a videostylet (VS) and a hyperangulated videolaryngoscope (HAVL)-in simulated grade 3 scenarios, compared to a standard geometry videolaryngoscope (SGVL) and SGVL with bougie assistance. Thirty-three second-year residents from various medical specialties, all with limited airway experience, were trained and randomly assigned to intubate two cadavers modified to replicate grade 3 views using each device. Outcomes included intubation success within 90 s, time to intubation, and difficulty rating via visual analogue scale (VAS). Success rates within 90 s were: SGVL 57.6%, SGVL + bougie 60.6%, HAVL 63.6%, and VS 87.9%. VS significantly exceeded SGVL in performance, with a hazard ratio of 2.5 and an odds ratio of 5.4 (95% CI of 1.4 to 4.4 and 1.7 to 17.7, respectively). VAS scores significantly correlated with success rates and times. In simulated grade 3 airway scenarios, the videostylet demonstrated potential as a superior option for managing these challenging airways, especially for less experienced operators. Device familiarity and training remain essential, and careful selection of backup devices is crucial when managing grade 3 laryngoscopic views.