Tracheal intubation in a simulated cervical spine immobilisation: The Macintosh laryngoscope versus supraglottic airway devices - A manikin study

Abstract

BackgroundAirway management is performed with simultaneous cervical spine immobilisation in trauma patients and is regarded as the gold standard. Application of spinal stabilisation may significantly worsen direct laryngoscopy and make intubation more difficult. Supraglottic airway devices may also be used for intubation. The aim of this study was to evaluate the Macintosh laryngoscope, the Classic Laryngeal Mask Airway and the I-gel used for blind intubation by experienced paramedics. Cervical collar was used to simulate reduced cervical spine mobility. Materials and methodsFifty-five experienced and active paramedics participated in the study (F = 25, M = 30). The intubation-to-successful-ventilation time was recorded. Efficacy of intubation and the ease of use by the operator were also assessed. All devices under study were used by each participant and they were randomly chosen. All participants were trained in supraglottic airway devices insertion and intubation although they were not experts in the latter as each of the paramedics performed less than 20 intubations. ResultsThe mean intubation-to-ventilation time was the shortest when the I-gel device was used 28.2 s (±2.09). This was statistically significant when compared to both the Classic Laryngeal Mask Airway (p = 0.0344) and the Macintosh laryngoscope (p < 0.0001). Both of the studied supraglottic airway devices achieved an overall 100% successful intubation rate and required maximum 2 attempts out of 3 allowed. ConclusionThe I-gel and the Classic Laryngeal Mask Airway were superior to the Macintosh laryngoscope as they shortened the time required to intubate and successfully ventilate the patient. They also improved the rate of successful intubation.