Success of blind tracheal intubation using the Auragain laryngeal airway compared with the Intubating Laryngeal Mask Airway (lma Fastrach) by novice users: A manikin study

Abstract

BackgroundThe Ambu® AuraGain™ is a new phthalate-free supraglottic airway device (SAD). It is disposable and has a preformed curvature similar to that of the Intubating Laryngeal Mask Airway (LMA Fastrach). It is proposed as a conduit for direct tracheal intubation assisted by a flexible scope. This study aims to compare the success of blind tracheal intubation via the AuraGain (AG) device, with that of the LMA Fastrach (FT) by novice users in manikins. Methods38 anaesthesia trainees/fellows and specialists with limited (<5 intubations) or no prior experience with intubating SADs were recruited for this manikin study. All participants attempted blind tracheal intubation with both devices up to two attempts and were allowed the use of a flexible bronchoscope on the third attempt if necessary. The primary outcome was first pass success at blind tracheal intubation. Overall success after 3 attempts, time to intubation, and ease of intubation on a visual analogue scale were also recorded. ResultsParticipants achieved a higher first pass success at blind tracheal intubation with FT compared to AG (FT 92.1%; AG 65.8%. p = 0.0049). By the third attempt, cumulative success rate was 97.4% for FT and 86.8% for the AG (p = 0.0888). Overall median ease of intubation recorded on a visual analogue scale was 2.0 out of 10 for FT and 4.0 for the AG. (p = 0.01). There was no significant difference in Time to intubation between the 2 devices (AG 103.8s vs FT 100.1, p = 0.6478). ConclusionsThe AuraGain had a significantly lower first attempt success rate at blind tracheal intubation compared with the LMA Fastrach, although there was no significant difference in overall success after 3 attempts. Intubating through the AuraGain was also deemed to be more difficult by novice users than the LMA Fastrach. Further clinical studies are required to evaluate blind intubation through the AuraGain.