Abstract
We aimed to compare the effectiveness of supraglottic airway devices as a strategy for unassisted tracheal intubation. Accordingly, we searched the OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, KoreaMed, and Google Scholar databases to identify all relevant randomized controlled trials (RCTs) on supraglottic airway devices as a strategy for tracheal intubation published until May 2017. The primary outcome was the overall success rate of intubation by the intention to treat (ITT) strategy. The secondary outcomes of the study were the overall success rate of tracheal intubation by the per protocol (PP) strategy and the success rate of tracheal intubation at first attempt by ITT and PP. We conducted a network meta-analysis with a mixed-treatment comparison method to combine direct and indirect comparisons among supraglottic airway devices. Of 1396 identified references, 16 RCTs (2014 patients) evaluated unassisted intubation with supraglottic airway devices. Patients were grouped according to the type of device used: LMA-CTrach, LMA-Fastrach, Air-Q, i-gel, CobraPLA, Ambu-Aura, or single-use LMA devices. Based on the surface under the cumulative ranking curve, the three best supraglottic airway devices for use as a strategy for unassisted tracheal intubation were LMA-CTrach (which included video-assisted tracheal tube guidance), single-use LMA-Fastrach, and LMA-Fastrach. LMA-Fastrach showed a higher success rate of intubation than did i-gel, CobraPLA, Air-Q, and Ambu-Aura. However, this study was limited by the small number of eligible RCTs. Therefore, well-designed RCTs performed on large patient populations are required to increase the confidence of the results.
Highlights
Tracheal intubation is considered a gold standard for airway maintenance, which prevents pulmonary aspiration with stable ventilation
supraglottic airway (SGA) devices designed for unassisted tracheal intubation have been developed
Endotracheal intubation using SGA devices is a widely investigated and accepted technique that has been recognized on the emergency pathway of the American Society of Anesthesiologists’ Difficult Airway Algorithm[2]
Summary
Tracheal intubation is considered a gold standard for airway maintenance, which prevents pulmonary aspiration with stable ventilation. Macintosh direct laryngoscopy is the gold standard. Owing to the high failure rate of the direct laryngoscope (up to 30%)[1], several devices including the videolaryngoscope and supraglottic airway (SGA). Supraglottic airway devices as a stategy for unassisted tracheal intubation devices have been developed[2, 3]. SGA devices designed for unassisted tracheal intubation have been developed. Endotracheal intubation using SGA devices is a widely investigated and accepted technique that has been recognized on the emergency pathway of the American Society of Anesthesiologists’ Difficult Airway Algorithm[2]
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