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Objectives: Little information about the performance of videolaryngoscopes outdoors is available. We aimed to test the hypothesis that a Macintosh direct laryngoscope would perform less well than videolaryngoscopes under difficult environmental conditions (high-altitude glacier, sun-reflecting snow).

Material And Methods: After local research ethics committee approval, this randomized controlled trial enrolled 20 physicians who intubated manikins with limited cervical extension mouth opening under 5 conditions: 1) in hospitals (indoors), 2) indoors at a high altitude, 3) outdoors on a glacier in sunlight without sunglasses, 4) outdoors on a glacier with sunglasses, and 5) outdoors on a glacier with the physician and manikin covered with a blanket.

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