Airtraq® versus Macintosh laryngoscope for airway management during general anesthesia: A systematic review and meta-analysis of randomized controlled trials

Abstract

INTRODUCTION: Despite the introduction of supraglottic devices for ventilation, endotracheal intubation is still a gold standard for airway management in both prehospital and operating theatre conditions. This systematic review and meta-analysis were conducted to investigate the effectiveness and safety of Airtraq vs. Macintosh laryngoscope for endotracheal intubation during general anesthesia. MATERIAL AND METHODS: The current issue of Pubmed, Embase, Cochrane, Web of science, Scopus (from database inception to October 20, 2020) was searched. Randomized controlled trials (RCT) comparing Airtraq and Macintosh laryngoscope were included in this meta-analysis. The primary outcomes were the success rate of first attempt intubation and intubation time. Secondary outcomes were overall intubation success rate, malposition, and adverse events. Review Manager 5.4 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. RESULTS: Seventeen studies were included in the review for data extraction. First attempt success rate was 85.6% for ATQ vs. 68.4% for MAC (OR = 3.00; 95% CI: 1.37, 6.60; p = 0.006; I2 = 63%). The use of ATQ and MAC for intubation in cervical spine immobilization was associated with the effectiveness of the first intubation attempt at 98.6% vs. 71.1% (OR = 16.40; 95% CI: 3.55, 78.87; p < 0.001; I2 = 0%). Intubation time with ATQ was shorter than with MAC (MD = -3.19; 95% CI: -9.33, 2.95; p = 0.31; I2 = 97%). The endotracheal intubation during cervical spinal intubation was associated with significantly shorter procedurę duration for ATQ than for MAC (MD = -10.30; 95% CI: -18.43, -2.18; p = 0.01; I2 = 74%). The total efficacy of intubation, which for ATQ and MAC varied and was 86.7% vs. 80.6% respectively (OR = 2.88; 95% CI: 1.61, 5.13; p < 0.001; I2 = 0%). CONCLUSIONS: Based on the results of this analysis, we conclude that ATQ can reduce the failed first intubation attempt, especially in cervical manual inline stabilization patients, and reduces the time needed to obtain airway management, but does not provide significant benefits on other adverse events associated with tracheal intubation. Further studies are needed to demonstrate whether severe adverse events are significantly different between the two devices.