Abstract
Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios.Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios.What is Known:• For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation.• Endotracheal intubation is considered by many scientific societies the gold standard for airway management.• Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation.What is New:• The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios.• It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.
Highlights
For pediatric resuscitation, bag-mask ventilation remains the recommended first-line method for airway control and ventilation [23]
The aim of the study was to compare the application of various Supraglottic airway devices (SADs) for blind intubation performed by inexperienced physicians in different pediatric airway scenarios
The need to quickly ensure airway patency becomes important in pediatric patients, in whom the inability to maintain airway patency and progressive hypoxia are the primary causes for cardiac arrest
Summary
Bag-mask ventilation remains the recommended first-line method for airway control and ventilation [23]. Intubation is among the most important procedures related to prognosis in severe cases [24]. Endotracheal intubation is considered by many scientific societies the gold standard for airway management [9, 23]. The need to quickly ensure airway patency becomes important in pediatric patients, in whom the inability to maintain airway patency and progressive hypoxia are the primary causes for cardiac arrest. Endotracheal intubation in pediatric patients is more challenging for medical personnel with greater risk of technical problems and complications. The success rate is influenced by several factors, including the intubator’s experience. Failed attempts can pose a risk for airway edema, hypoxia, and bleeding [17]
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