Hyperangulated Versus Standard Geometry Laryngoscope Blade Trial

NCT07223762 | Enrolling By Invitation DMC

• 1 other identifier: 250433
• Study Type: interventional
• Target: 2,500
• Locations: 1 country
• Sites: 16

Brief Summary

The Hyperangulated versus Standard Geometry Laryngoscope Blade (ANGLE) Trial is a multi-center, non-blinded, parallel-group, randomized clinical trial evaluating the effect of use of a hyperangulated video laryngoscope blade versus use of a standard geometry video laryngoscope blade. Critically ill adults undergoing tracheal intubation in participating EDs and ICUs who meet eligibility criteria will be enrolled and randomly assigned in a 1:1 ratio to either intubation using a hyperangulated video laryngoscope blade or a standard geometry video laryngoscope blade. The primary outcome is the incidence of successful intubation on the first attempt. The secondary outcome is incidence of hypoxemia during the interval between induction and 2 minutes after tracheal intubation.

Conditions

Acute Respiratory Failure

Keywords

critical illness; emergency airway management; tracheal intubation; video laryngoscope

Outcome Measures

Primary Outcomes (1)

• Successful intubation on the first attempt.

  Successful intubation on the first attempt is defined as placement of an endotracheal tube in the trachea with a single insertion of a laryngoscope blade into the mouth and EITHER a single insertion of an endotracheal tube into the mouth OR a single insertion of a bougie into the mouth followed by a single insertion of an endotracheal tube over the bougie into the mouth.

  Duration of placement of the endotracheal tube, an average duration of two minutes.

Secondary Outcomes (1)

• Hypoxemia

  During the interval between induction and 2 minutes after tracheal intubation.

Other Outcomes (13)

• Cormack-Lehane grade of glottic view

  Duration of placement of the endotracheal tube, an average duration of two minutes.

• Number of laryngoscopy attempts

  Duration of placement of the endotracheal tube, an average duration of two minutes.

• Number of bougie attempts

  Duration of placement of the endotracheal tube, an average duration of two minutes.

Study Arms (2)

Hyperangulated video laryngoscope blade

ACTIVE COMPARATOR

For patients assigned to the hyperangulated video laryngoscope blade group, the operator will use a hyperangulated video laryngoscope blade on the first laryngoscopy attempt.

Other: Hyperangulated video laryngoscope blade

Standard Geometry Video Laryngoscope Blade Group

ACTIVE COMPARATOR

For patients assigned to the standard geometry laryngoscope blade group, the operator will use a standard geometry video laryngoscope blade on the first laryngoscopy attempt.

Other: Standard geometry video laryngoscope blade

Interventions

Standard geometry video laryngoscope blade OTHER

Standard geometry video laryngoscope blade

Standard Geometry Video Laryngoscope Blade Group

Hyperangulated video laryngoscope blade OTHER

Hyperangulated video laryngoscope blade

Hyperangulated video laryngoscope blade

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient is located in a participating unit.
• Planned procedure is orotracheal intubation using a laryngoscope.
• Planned operator is a clinician expected to routinely perform tracheal intubation in the participating unit.

You may not qualify if:

• Patient is known to be less than 18 years old.
• Patient is known to be pregnant.
• Patient is known to be a prisoner.
• Immediate need for tracheal intubation precludes safe performance of study procedures.
• Operator has determined that use of a direct laryngoscope is required for the optimal care of the patient.
• Operator has determined that use of a hyperangulated video laryngoscope blade or a standard geometry video laryngoscope blade is required or contraindicated for the optimal care of the patient either because of factors related to the patient (e.g., patient's upper airway anatomy requires a specific blade type) or the operator (e.g., treating clinicians lack sufficient comfort with one of the blade types).

Sponsors & Collaborators

• Vanderbilt University Medical Center: lead

Study Sites (16)

University of California, Los Angeles

Los Angeles, California, 90095, United States

Location

Stanford University

Stanford, California, 94305, United States

Location

University of Colorado, Denver Anschutz Medical Campus

Denver, Colorado, 80045, United States

Location

Denver Health Medical Center

Denver, Colorado, 80204, United States

Location

Rush University Medical Center

Chicago, Illinois, 60612, United States

Location

Our Lady of the Lake Hospital, Inc.

Baton Rouge, Louisiana, 70808, United States

Location

Ochsner Clinic Foundation

Jefferson, Louisiana, 70121, United States

Location

University of Maryland Baltimore

Baltimore, Maryland, 21201, United States

Location

Lahey Clinic, Inc

Burlington, Massachusetts, 01805, United States

Location

Hennepin Healthcare component - Hennepin County Medical Center

Minneapolis, Minnesota, 55415, United States

Location

Duke University Medical Center

Durham, North Carolina, 27710, United States

Location

Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27109, United States

Location

The Ohio State University

Columbus, Ohio, 43210, United States

Location

Oregon Health & Science University

Portland, Oregon, 97239, United States

Location

Vanderbilt University Medical Center

Nashville, Tennessee, 37232, United States

Location

Baylor Scott & White Research Institute

Dallas, Texas, 75201, United States

Location

Related Publications (14)

• Zhang J, Tan LZ, Toh H, Foo CW, Wijeratne S, Hu H, Seet E. Comparing the first-attempt tracheal intubation success of the hyperangulated McGrath(R) X-blade vs the Macintosh-type CMAC videolaryngoscope in patients with cervical immobilization: a two-centre randomized controlled trial. J Clin Monit Comput. 2022 Aug;36(4):1139-1145. doi: 10.1007/s10877-021-00746-5. Epub 2021 Aug 4.

  PMID: 34347225 RESULT

• Kohl V, Wunsch VA, Muller MC, Sasu PB, Dohrmann T, Peters T, Tolkmitt J, Dankert A, Krause L, Zollner C, Petzoldt M. Hyperangulated vs. Macintosh videolaryngoscopy in adults with anticipated difficult airway management: a randomised controlled trial. Anaesthesia. 2024 Sep;79(9):957-966. doi: 10.1111/anae.16326. Epub 2024 May 24.

  PMID: 38789407 RESULT

• Paik H, Park HP. Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine. BMC Anesthesiol. 2020 Aug 15;20(1):201. doi: 10.1186/s12871-020-01118-3.

  PMID: 32799791 RESULT

• Suppan L, Tramer MR, Niquille M, Grosgurin O, Marti C. Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2016 Jan;116(1):27-36. doi: 10.1093/bja/aev205. Epub 2015 Jun 30.

  PMID: 26133898 RESULT

• van Zundert A, Pieters B, Doerges V, Gatt S. Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy. Br J Anaesth. 2012 Dec;109(6):1014-5. doi: 10.1093/bja/aes418. No abstract available.

  PMID: 23154957 RESULT

• 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. 2016 May;116(5):670-9. doi: 10.1093/bja/aew058.

  PMID: 27106971 RESULT

• Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022 Apr 4;4(4):CD011136. doi: 10.1002/14651858.CD011136.pub3.

  PMID: 35373840 RESULT

• Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, Vonderhaar DJ, Whitson MR, Barnes CR, Walco JP, Douglas IS, Krishnamoorthy V, Dagan A, Bastman JJ, Lloyd BD, Gandotra S, Goranson JK, Mitchell SH, White HD, Palakshappa JA, Espinera A, Page DB, Joffe A, Hansen SJ, Hughes CG, George T, Herbert JT, Shapiro NI, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz DR, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW; DEVICE Investigators and the Pragmatic Critical Care Research Group. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023 Aug 3;389(5):418-429. doi: 10.1056/NEJMoa2301601. Epub 2023 Jun 16.

  PMID: 37326325 RESULT

• Prekker ME, Trent SA, Lofrano A, Russell DW, Barnes CR, Brewer JM, Doerschug KC, Gaillard JP, Gandotra S, Ginde AA, Ghamande S, Gibbs KW, Hughes CG, Janz DR, Khan A, Mitchell SH, Page DB, Rice TW, Self WH, Smith LM, Stempek SB, Vonderhaar DJ, West JR, Whitson MR, Casey JD, Semler MW, Driver BE. Laryngoscopy and Tracheal Intubation: Does Use of a Video Laryngoscope Facilitate Both Steps of the Procedure? Ann Emerg Med. 2023 Oct;82(4):425-431. doi: 10.1016/j.annemergmed.2023.02.016. Epub 2023 Apr 5.

  PMID: 37028995 RESULT

• Park L, Zeng I, Brainard A. Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. Emerg Med Australas. 2017 Feb;29(1):40-47. doi: 10.1111/1742-6723.12704. Epub 2016 Oct 27.

  PMID: 27785883 RESULT

• Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med. 2015 Apr;65(4):363-370.e1. doi: 10.1016/j.annemergmed.2014.10.036. Epub 2014 Dec 20.

  PMID: 25533140 RESULT

• Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, Lascarrou JB, Szuldrzynski K, Camporota L, Pelosi P, Sorbello M, Higgs A, Greif R, Putensen C, Agvald-Ohman C, Chalkias A, Bokums K, Brewster D, Rossi E, Fumagalli R, Pesenti A, Foti G, Bellani G; INTUBE Study Investigators. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021 Mar 23;325(12):1164-1172. doi: 10.1001/jama.2021.1727.

  PMID: 33755076 RESULT

• Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Kovacs G, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Jones PM; Canadian Airway Focus Group. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth. 2021 Sep;68(9):1405-1436. doi: 10.1007/s12630-021-02008-z. Epub 2021 Jun 8.

  PMID: 34105065 RESULT

• Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013 Jan;20(1):71-8. doi: 10.1111/acem.12055.

  PMID: 23574475 RESULT

MeSH Terms

Conditions

Critical Illness

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Primary Investigator

Model Details: Parallel group, pragmatic, randomized clinical trial

Study Record Dates

• First Submitted: October 30, 2025
• First Posted: November 3, 2025
• Study Start: December 30, 2025
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): May 1, 2027
• Last Updated: April 8, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP

Locations

US (16)