The novel video‐assisted intubating laryngeal mask Totaltrack compared to the intubating laryngeal mask Fastrach – a controlled randomized manikin study

Abstract

The novel Totaltrack combines a supraglottic airway device with video laryngoscopic tracheal intubation. The intubation laryngeal mask Fastrach is an established device without visual control of intubation. We hypothesized that supraglottic ventilation success with Totaltrack would be similar to Fastrach, but intubation would be performed faster due to visual control of the procedure. Fifty-five anaesthesiologists were randomized into one of two study arms: Fastrach Totaltrack. After a standardized introduction, six consecutive attempts of supraglottic ventilation and intubation attempts with each of one of the devices were performed on an airway manikin. The combined primary outcome was: time to supraglottic ventilation and time to ventilation after intubation. Additionally, success rate and learning curves were evaluated. Supraglottic time to ventilation was shorter when using the Fastrach compared to the Totaltrack (median: 7.8s [confidence interval [CI]: 7.0-8.6s] vs. 11s [CI: 7.8-14.2s], P<0.001). Intubation was faster using the Fastrach compared to Totaltrack (median: 12.5s, [CI: 10.1-14.9s] vs. 23.3s [CI: 21.5-25.1s], P<0.001). Success rate for supraglottic ventilation was comparable between Fastrach and Totaltrack (86-96%). Successful intubation via the device was 100% in Fastrach and ranged from 61% to 93% in Totaltrack, with a higher probability of successful intubation after four applications. In this manikin-based study the novel Totaltrack did not prove superior to Fastrach despite a similar design. Video laryngoscopic control of supraglottic ventilation and endotracheal intubation was prolonged using the Totaltrack. Clinical trials are mandatory to evaluate the role of the Totaltrack in airway management.