Letter to the Editor
Dr. Darren Braude's overview of extraglottic airway devices was excellent (EMN 2011;33:32; http://bit.ly/BraudeEAD), as are all of his discussions on airway management. He lists several different types of EADs, and seems open to looking at new technology. He also states that he is “not suggesting that I am ready to get rid of my beloved ET tube.” One new airway technology he did not mention is a relatively new technology for oral endotracheal intubation: the Grandview Laryngoscopy Blade (Hartwell Medical Supply, Carlsbad, CA). Many of the challenges that occur with the Miller and McIntosh blades are improved with the Grandview.
A peer-reviewed study, even though using a small sample size, demonstrated equivalent or improved results over the Miller and McIntosh blades. (Am J Emerg Med 2008;26:952.) The Ripon, CA, Fire Department performed a field study on oral intubation rates with the Grandview Blade. Prior to obtaining and using the blade, their intubation success rate was 77 percent. After adding and utilizing the Grandview laryngoscopy blade, this improved to 95 percent. (http://www.hartwellmedical.com.)
The advantage of the Grandview Blade is its unique curvature (15 degrees) that allows it to conform to the upper airway better yet still allow the direct line of sight necessary to view the cords. It is also 80 percent wider, permitting the clinician to pass the tube over the tongue easily as it moves through the cords. The flange also provides adequate room for passing the tube. The combination of curvature and width allows the blade to be placed on top of the tongue, and lets the tip of the blade move easily to the vallecula and epiglottis. (Ann Emerg Med 2011;57:240.)
The Grandview is being used nationwide in many emergency medical services and emergency departments with wide success. The degree of success is still being evaluated, but it appears that direct laryngoscopy is still the most used technique. The Grandview blade would be worth considering for use and further studies.
Cary N. Schneider, DO, MPH
Dr. Schneider invented the Grandview blade.