The VCI score is a new and simple communication tool to describe tracheal intubation using videolaryngoscopy. It encompasses three critical components thought to be relevant to videolaryngoscopy use:

  • Generic blade shape
  • Glottic view at the point of tracheal intubation or attempted intubation using POGO
  • Ease of tracheal tube delivery

The first element of the score considers the type of videolaryngoscopy blade used. The ‘M’ refers to a Macintosh-shaped blade, ‘H’ for a hyperangulated blade and ‘S’ for a straight shaped laryngoscope blade.

The second component describes the percentage of glottic opening (POGO) visible to the nearest quartile at the time of intubation. This is a crucial nuance since the glottic view, which allows successful tracheal intubation to be achieved, may not necessarily be the initial or best view obtained.

The last part of the score describes tracheal tube delivery and is detailed by one of the following qualitative terms: Easy (‘E’), Difficult (‘D’), or Failed (‘F’). While subjective, the following provides a pragmatic guide:

  • Easy: straightforward first-time intubation of the trachea (minor adjustments to rotate the tube to avoid the arytenoids and hold up are acceptable. For hyperangulated blades, the use of a stylet is part of the technique and does not constitute an airway adjunct). Channel should be specified if the channel was used for tube delivery when using channelled blades.
  • Difficult: Everything between the two extremes of Easy and Failed and indicates that tube delivery was not straightforward and something ‘else’ had to be done to enable passage of the tube such as manipulation of the tracheal tube with additional equipment (e.g. change from a stylet to a bougie or vice versa). A free-text comment must be provided highlighting any difficulties.
  • Failed: Inability to intubate the trachea despite the use of adjuncts. Again comments highlighting the reason for failure should be provided.

The resulting score has three parts. For example, M75E would represent tracheal intubation using a Macintosh-shaped videolaryngoscopy blade with a 75% glottic opening at the time of tracheal intubation, which was uncomplicated.

The airway grade H50D (flexible scope) would represent tracheal intubation using a hyperangulated blade with 50% glottic opening at the time of tracheal intubation. Additionally, a flexible scope was required to enable passage of the tracheal tube.