{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:11:06Z","timestamp":1776445866462,"version":"3.51.2"},"reference-count":44,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,11]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rapid sequence induction of anaesthesia is indicated in patients with an increased risk of pulmonary aspiration. The main objective of the technique is to reduce the critical time period between loss of airway protective reflexes and rapid inflation of the cuff of the endotracheal tube to minimise the chance of aspiration of gastric contents. The COVID-19 pandemic has reinforced the importance of first-pass intubation success to ensure patient and healthcare worker safety. The aim of this study is to compare the first-pass intubation success rate (FPS) using the videolaryngoscopy compared with conventional direct laryngoscopy in surgical patients with a high risk of pulmonary aspiration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The LARA trial is a multicentre, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath MAC videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of FPS is 92% in the McGrath group and 82% in the Macintosh group. Each group must include a total of 500\u2009patients to achieve 90% power for detecting a difference at the 5% significance level. Successful intubation with the FPS is the primary endpoint. The secondary endpoints are the time to intubation, the number of intubation attempts, the necessity of airway management alternatives, the visualisation of the glottis using the Cormack and Lehane Score and the Percentage Of Glottic Opening Score and definite adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (registration number: 2020\u201315502) and medical ethics committee of the University of Freiburg (registration number: 21\u20131303). The results of this study will be made available in form of manuscripts for publication and presentations at national and international meetings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04794764\">NCT04794764<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052977","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T15:13:32Z","timestamp":1666710812000},"page":"e052977","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Anaesthesia protocol evaluation of the videolaryngoscopy with the McGrath MAC and direct laryngoscopy for tracheal intubation in 1000 patients undergoing rapid sequence induction: the randomised multicentre LARA trial study protocol"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct04794764","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7350-7908","authenticated-orcid":false,"given":"Marc","family":"Kriege","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Pirlich","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva-Verena","family":"Griemert","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Heid","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Wittenmeier","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Schmidtmann","sequence":"additional","affiliation":[{"name":"Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg Universitat Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Schmidbauer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care Medicine and Emergency Medicine, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"J\u00e4nig","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care Medicine and Emergency Medicine, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Jungbecker","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care Medicine and Emergency Medicine, Marienhaus Klinikum Hetzelstift Neustadt Weinstra\u00dfe, Neustadt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Kunitz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Emergency and Intensive Care Medicine, Klinikum Mutterhaus der Borrom\u00e4erinnen gGmbH, Trier, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Strate","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University of Freiburg, Freiburg im Breisgau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Schmutz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University of Freiburg, Freiburg im Breisgau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,6]]},"reference":[{"key":"2025121509283571000_11.10.e052977.1","doi-asserted-by":"crossref","first-page":"633???636","DOI":"10.1213\/00000539-197007000-00027","article-title":"Rapid induction-intubation for prevention of gastric-content aspiration","volume":"49","author":"Stept","year":"1970","journal-title":"Anesth Analg"},{"key":"2025121509283571000_11.10.e052977.2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.1999.00738.x"},{"key":"2025121509283571000_11.10.e052977.3","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1111\/j.1365-2044.2001.01962.x","article-title":"Rapid sequence induction: a national survey of practice","volume":"56","author":"Morris","year":"2001","journal-title":"Anaesthesia"},{"key":"2025121509283571000_11.10.e052977.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05681.x"},{"key":"2025121509283571000_11.10.e052977.5","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000122825.04923.15"},{"key":"2025121509283571000_11.10.e052977.6","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer058"},{"key":"2025121509283571000_11.10.e052977.7","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/anae.13714","article-title":"Evaluation of three unchannelled videolaryngoscopes and the MacIntosh laryngoscope in patients with a simulated difficult airway: a randomised, controlled trial","volume":"72","author":"Kleine-Brueggeney","year":"2017","journal-title":"Anaesthesia"},{"key":"2025121509283571000_11.10.e052977.8","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12075"},{"key":"2025121509283571000_11.10.e052977.9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/EJA.0b013e32832d328d","article-title":"Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope","volume":"27","author":"Serocki","year":"2010","journal-title":"Eur J Anaesthesiol"},{"key":"2025121509283571000_11.10.e052977.10","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1111\/j.1365-2044.2011.06872.x","article-title":"Performance of the C-MAC video laryngoscope in patients after a limited glottic view using MacIntosh laryngoscopy","volume":"66","author":"Piepho","year":"2011","journal-title":"Anaesthesia"},{"key":"2025121509283571000_11.10.e052977.11","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318246ea34"},{"key":"2025121509283571000_11.10.e052977.12","first-page":"869","article-title":"Comparison of McGrath(\u00ae) Series 5 video laryngoscope with Macintosh laryngoscope: A prospective, randomised trial in patients with normal airways","volume":"32","author":"Sargin","year":"2016","journal-title":"Pak J Med Sci"},{"key":"2025121509283571000_11.10.e052977.13","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/anae.12322","article-title":"A randomised controlled trial comparing the GlideScope(\u00ae) and the Macintosh laryngoscope for double-lumen endobronchial intubation","volume":"68","author":"Russell","year":"2013","journal-title":"Anaesthesia"},{"key":"2025121509283571000_11.10.e052977.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer099"},{"key":"2025121509283571000_11.10.e052977.15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-11-6"},{"key":"2025121509283571000_11.10.e052977.16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00101-015-0109-4","article-title":"S1 guidelines on airway management: guideline of the German Society of Anesthesiology and Intensive Care Medicine","volume":"64 Suppl 1","author":"Piepho","year":"2015","journal-title":"Anaesthesist"},{"key":"2025121509283571000_11.10.e052977.17","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-013-0019-3"},{"key":"2025121509283571000_11.10.e052977.18","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31827773b2"},{"key":"2025121509283571000_11.10.e052977.19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev371"},{"key":"2025121509283571000_11.10.e052977.20","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/anae.15301","article-title":"Aerosolisation during tracheal intubation and extubation in an operating theatre setting","volume":"76","author":"Dhillon","year":"2021","journal-title":"Anaesthesia"},{"key":"2025121509283571000_11.10.e052977.21","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15054"},{"key":"2025121509283571000_11.10.e052977.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2010.06388.x"},{"key":"2025121509283571000_11.10.e052977.23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jclinane.2017.12.030","article-title":"McGrath videolaryngoscope versus MacIntosh laryngoscope for tracheal intubation: a systematic review and meta-analysis with trial sequential analysis","volume":"46","author":"Hoshijima","year":"2018","journal-title":"J Clin Anesth"},{"key":"2025121509283571000_11.10.e052977.24","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14057"},{"key":"2025121509283571000_11.10.e052977.25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12630-021-01921-7","article-title":"A systematic review of meta-analyses comparing direct laryngoscopy with videolaryngoscopy","volume":"68","author":"Downey","year":"2021","journal-title":"Can J Anaesth"},{"key":"2025121509283571000_11.10.e052977.26","first-page":"CD011136","article-title":"Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation","volume":"11","author":"Lewis","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121509283571000_11.10.e052977.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2006.04653.x"},{"key":"2025121509283571000_11.10.e052977.28","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1097\/EJA.0000000000000525","article-title":"C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department","volume":"33","author":"Sulser","year":"2016","journal-title":"Eur J Anaesthesiol"},{"key":"2025121509283571000_11.10.e052977.29","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001084"},{"key":"2025121509283571000_11.10.e052977.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.03.031"},{"key":"2025121509283571000_11.10.e052977.31","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/1742-6723.12358","article-title":"Comparison of the C-MAC video laryngoscope with direct MacIntosh laryngoscopy in the emergency department","volume":"27","author":"Vassiliadis","year":"2015","journal-title":"Emerg Med Australas"},{"key":"2025121509283571000_11.10.e052977.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2010.02.024"},{"key":"2025121509283571000_11.10.e052977.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1999.tb00091.x"},{"key":"2025121509283571000_11.10.e052977.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.01.009"},{"key":"2025121509283571000_11.10.e052977.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(02)00501-2"},{"key":"2025121509283571000_11.10.e052977.36","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12005"},{"key":"2025121509283571000_11.10.e052977.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"2025121509283571000_11.10.e052977.38","article-title":"Airway difficulty score (ads): a new score to predict difficulty in airway management","volume":"17","author":"Janssens","year":"2000","journal-title":"Eur J Anaesthesiol"},{"key":"2025121509283571000_11.10.e052977.39","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/64.5.571"},{"key":"2025121509283571000_11.10.e052977.40","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-009-9084-z"},{"key":"2025121509283571000_11.10.e052977.41","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-013-9991-x"},{"key":"2025121509283571000_11.10.e052977.42","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199712000-00005"},{"key":"2025121509283571000_11.10.e052977.43","first-page":"1291","article-title":"[Comparison of tracheal intubation performance between macintosh direct laryngoscope and McGRATH\u00ae MAC video laryngoscope among anesthesia trainees]","volume":"64","author":"Kasuya","year":"2015","journal-title":"Masui"},{"key":"2025121509283571000_11.10.e052977.44","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12804"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-052977","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:28:45Z","timestamp":1765819725000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-052977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,6]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bmjopen-2021-052977"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-052977","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}