Blind Intubation Research Articles

Use of the intubating laryngeal mask airway in the emergency department: A ten-year retrospective review

BackgroundExtraglottic devices, such as the intubating laryngeal mask airway (ILMA), facilitate ventilation and oxygenation and are useful for emergency airway management, especially as rescue devices. In the operating room setting the ILMA has been highly successful. However, its performance in the ED has not been described. We sought to describe the indications for and success of the ILMA when used in the ED. MethodsWe performed retrospective, observational study of patients who had an LMA® Fastrach™ (hereafter termed ILMA) placed in a single ED between 2007 and 2017. Patients were identified by keyword search of ED notes in the electronic medical record. Trained abstractors reviewed charts and videos to determine patient characteristics, indication for ILMA placement, success of oxygenation and ventilation, intubation methods and success, and complications related to the device. ResultsDuring the study period 218 patients had an ILMA placed in the ED. The ILMA was used as a primary device in 118 patients (54%), and as a rescue device in 100 patients (46%). The median number of ILMA uses per faculty physician during the study period was 3. The ILMA oxygenated and ventilated successfully in 212 instances (98%), including 96 times (96%) when used as a rescue airway. Failure of oxygenation was due to tracheal injury (2), abnormal laryngeal inlet anatomy (2), or poor operator technique (1). Intubation through the ILMA was successful in 159 of 192 patients (83%), including a success rate of 81% (112 of 139 patients) with blind intubation. ConclusionThe ILMA was highly successful in oxygenation, with reasonable intubation success, even when used infrequently by emergency physicians. The ILMA should be considered a valuable primary and rescue intubation device in the ED.

Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D, Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial.

The use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario. We compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin. Thirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation. All participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42s, 56s, and 56s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29s and 40s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation. In an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.

Comparison of endoscopy-guided and blind orotracheal intubation techniques and their correlation with sedation quality and airway damage in rabbits

Comparison of endoscopy-guided and blind orotracheal intubation techniques and their correlation with sedation quality and airway damage in rabbits

Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study.

Purpose This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p < 0.05 between two devices or p < 0.017 in post hoc analysis of the comparison among three devices. Results The mean intubation time using IGI was shorter (p < 0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p < 0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p < 0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.

I-Gel and ILMA for ease of insertion and as conduit for intubation- A comparative study

Materials and methods: A total 120 cases undergoing elective surgery requiring general anaesthesia between age group 20-60 years were recruited. Cases were induced with suitable induction agents and non-depolarizing muscle relaxants and ventilated for 3 minutes before SAD insertion and again ventilated for 1 minute before blind ETT intubation. Parameters such as ease of insertion, number of attempts and time period of insertion of SADs and ETT, post-operative clinical complications were assessed.

A comparison of blind intubation with the intubating laryngeal mask FASTRACH\u2122 and the intubating laryngeal mask Ambu Aura-i\u2122 a prospective randomised clinical trial

BackgroundThe intubating laryngeal mask Fastrach™ is considered a gold standard for blind intubation as well as for fibreoptic guided intubation via a laryngeal mask. Recently, a single use version of the mask has been introduced. We compared the Fastrach single use with the new, low-priced single use intubating laryngeal mask Ambu Aura-i™.We hypothesised that the LMA Ambu Aura-i and the LMA Fastrach are comparable with respect to success rates for mask placement and blind tracheal intubation through the LMA device.MethodsA prospective, randomised clinical trial. University Hospital Schleswig-Holstein, Campus Kiel, from April 2011 to April 2012.Eighty patients undergoing general anaesthesia with planned tracheal intubation were randomised and enrolled in the study. Blind intubation was performed with either laryngeal mask using two different tracheal tubes (Rüsch Super Safety Silk™ and LMA ETT™). A crossover-design was performed after an unsuccessful procedure.Primary outcome measure was the overall success rate of blind intubation. Secondary outcome measures were the time to the first adequate ventilation, a subjective handling score, and a fibreoptic control of placement, as well as the success rate of mask placement, time for mask removal after successful intubation, differences in airway leak pressure, and the incidence of postoperative sore throat and hoarseness.ResultsThe success rate of tracheal intubation with the Fastrach for the first and second attempt was significantly better compared with the Ambu Aura-i. Tracheal intubation was also significantly faster (14.1 s. ±4.4 versus 21.3 s. ±9.0; p < 0.01), and the time interval for mask removal after successful intubation was significantly shorter using the Fastrach device (24.0 s. ±8.2 versus 29.4 s. ±7.5; p < 0.001). There were no significant differences between groups regarding the incidence of postoperative sore throat and hoarseness.ConclusionBoth laryngeal mask devices are suitable for ventilation and oxygenation. Blind intubation remains the domain of the LMA Fastrach, the Ambu Aura-i is not suitable for blind intubation.Trial registrationClinicaltrials.gov Identification Number NCT03109678, retrospectively registered on April 12, 2017.

Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study

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.

Windshield glass fragment mimicking a nasal fracture

A male patient with facial trauma by road traffic accident arrived in the emergency room and he was assisted by the Trauma and Neurosurgery team. After clinical evaluation a frontal sinus anterior wall fracture plus a nasal fracture were diagnosed. On the primary OMS examination was checked multiple facial lacerations and gross nasal dorsum deviation with pain, nasal airway obstruction and crepitus with clinical diagnosis of a nasal fracture. After radiologic exam a piece of windshield glass that was superimposed on the nasal bones simulating a nasal fracture was visualized. This paper presents clinical data and literature review of foreign body mimicking facial fractures.Descriptors: Road Traffic Accident; Facial Fractures; Windshield Glass.ReferênciasMazinis E, Lambrianidis T, Margelos J. Detection of a residual foreign body during root canal treatment. J Endod. 2005;31(9):691-93. Gray ST. Windshield safety glass foreign body masquerading as a root fragment. Dentomaxillofac Radiol. 1994;23(1):49-51.Goldstein E, Gottlieb MA. Foreign bodies in the nasal fossae of children. Oral Surg Oral Med Oral Pathol. 1973;36(3):446-47 .Madhere S, Barba CA, Painter RL, Morgan AS. Aspiration of shattered windshield glass after blind nasotracheal intubation in a motor vehicle crash. J Trauma. 1997;43:353-56.

Application of evidence-based nursing in blind intubation of helico-nasointestinal tube in patients with stroke-associated pneumonia in intensive care unit

Objective To study the effect of evidence-based nursing in patients with cerebral apoplexy in ICU by blind bedside spiral nasointestinal tube application. Methods To choose between September 2016 and September 2017 in our hospital ICU were 140 cases of patients with cerebral apoplexy as analysis object, randomly divided into two groups, two groups all use bedside blind spiral nose long intestinal tube technology, the control group using conventional nursing method for nursing, observation group using evidence-based nursing intervention, compared two groups of a success rate of catheter, accident to take off the tube (unscheduled decannulation rate), reflux hiccups, vomiting incidence of aspiration and patient satisfaction. Results The success rate of catheterization in the observation group was higher than that in the control group, and the incidence of accidental catheterization was lower than that in the control group. The incidence of reflux hiccup and vomiting aspiration was significantly lower than that in the control group, and the patient satisfaction was higher than that in the control group (all P<0.05). Conclusion For patients with cerebral apoplexy in the ICU bed of blind plug spiral nasal bowel technology combined evidence-based nursing intervention, clinical effect is remarkable, improve the success rate of catheter, reduces the surprise success rate of tube, unscheduled tube drawing number, reduces the incidence of reflux hiccups, vomiting aspiration, improve patient satisfaction and quality of life. Key words: Evidence-based nursing; Intensive care unit; Spiral nasal catheter blind insertion technique; Nasogastric tube placement technique

Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema

BackgroundNasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. MethodsWe performed a randomized, crossover manikin study using a convenience sample of emergency physicians and medical students from a local community teaching hospital. Using a simulated angioedema model, we sought to compare the time required to successfully perform nasotracheal intubation between traditional blind nasotracheal intubation and FNI. Participants performed nasal intubation with both FNI using the Ambu aScope Slim (Ambu, Ballarup, Denmark) and blind nasal intubation with a Parker Endotrol tube (Parker, CO) in random order. Number of attempts and time to successful intubation (TTI) were compared between treatment devices. Providers were stratified by experience level, defining junior providers as post-graduate level 2 and below (including medical students) and all others as senior providers. ResultsWe enrolled a convenience sample of 20 providers ranging from medical students to attendings. Overall, the TTI did not differ between blind and FNI intubation techniques (difference in seconds; 95% confidence interval) (21.4; −2.1 to 44.9; p = 0.07). This was consistent across provider types: senior providers (26.6; −17.7 to 71; p = 0.24) and junior providers (18.6; −8.3 to 46.5; p = 0.18). Number of attempts was similar between techniques (p = 0.55). ConclusionFNI and blind nasal intubation require similar time to intubation in this simulated model of angioedema.

A Synopsis of Contemporary Anesthesia Airway Management

New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.

Comparison of success rate of BlockBuster® versus Fastrach® LMA as conduit for blind endotracheal intubation: A prospective randomised trial.

Background and Aims:BlockBuster® Laryngeal Mask Airway, a newer supraglottic airway device, is claimed to be an efficient conduit for endotracheal intubation. Intubating laryngeal mask airway (LMA) is an established device for the same. This randomised study was undertaken to evaluate the success rate of blind intubation using either of these LMAs.Methods:Sixty patients of age group 20-60 years undergoing general anaesthesia were randomised in 2 groups, of 30 patients each, for tracheal intubation using either BlockBuster® LMA (Group B) or the Intubating LMA Fastrach® (Group F). After induction of anaesthesia, LMAs were inserted and on achieving adequate ventilation with the device, fibreoptic scopy was performed to assess the glottis visualisation score. Blind intubation was attempted through the supraglottic airway devices (SAD). The primary objective was first pass successful intubation and secondary outcomes were ease, time for LMA insertion, oropharyngeal seal pressure (OSP), LMA removal time, fibreoptic scoring and complications. Data was analysed using SPSS V22 software.Results:The first-attempt success rate of tracheal intubation was 90% in Group B and 66.6% in Group F (P = 0.028), while the overall success rate of intubation was 96.6% in Group B and 89.9% in Group F (P = 0.3). The OSP in Group B was 33.7 ± 1.8 and 22.7 ± 1.5 cm H2O in Group F (P = 0.001). Complications such as sore throat and blood stain were reduced with BlockBuster® LMA.Conclusion:BlockBuster® LMA provides higher first pass success rate of blind tracheal intubation with less complications like sore throat and blood staining.

Blind Tracheal Intubation through the Air-Q Intubating Laryngeal Airway in Pediatric Patients: Reevaluation - A Randomized Controlled Trial.

Context:Some pediatric supraglottic airway devices have not been evaluated in a large perspective for blind intubation although they are validated as a conduit for fiberoptic-guided intubation.Objective:The objective of this study was to compare the success rate of blind technique with correction maneuvers versus fiberoptic-guided intubation through the air-Q laryngeal airway in pediatric patients.Patients and Methods:One hundred and twenty-six pediatric patients undergoing elective surgery under general anesthesia were randomized into two equal groups. The air-Q was placed in all patients as a conduit for tracheal intubation. Group B patients underwent blind intubation with correction maneuvers. Group F patients underwent fiberoptic-guided intubation.Results:There was no significant difference between the groups regarding the success rate of intubation or postextubation complications. Group F patients showed a significantly longer time to intubation and total time of the trial. Furthermore, Group F patients showed a significantly higher level of pre- and postintubation heart rate compared to Group B patients.Conclusion:Blind tracheal intubation in pediatric patients through the air-Q with correction maneuvers could be a good alternative for fiberoptic-guided intubation with stable hemodynamics and shorter time till intubation.

Ambu AuraGain versus intubating laryngeal tube suction as a conduit for endotracheal intubation.

Background and Aims:Newly developed supraglottic airway devices (SGAs) are designed to be used both for ventilation and as conduits for endotracheal intubation with standard endotracheal tubes (ETTs). We compared the efficacy of the Ambu AuraGain (AAG) and the newly developed intubating laryngeal tube suction disposable (ILTS-D) as conduits for blind and fiber-optically guided endotracheal intubation in an airway mannequin.Material and Methods:This is a prospective, randomized, crossover study in an airway mannequin, with two arms: blind ETT insertion by medical students and fiber-optically guided ETT insertion by anesthesiologists. The primary outcome variable was the time to achieve an effective airway through an ETT using AAG and ILTS-D as conduits. Secondary outcome variables were the time to achieve effective supraglottic ventilation and successful exchange with an ETT, and the success rates for blind endotracheal intubation and fiber-optically guided intubation techniques for both SGAs.Results:Forty participants were recruited to each group. All participants were able to insert both devices successfully on the first attempt. For blind intubation, the success rate for establishing a definitive airway with an ETT using the SGA as a conduit was significantly higher with ILTS-D (82.5%) compared with AAG (20.0%) (P < 0.001). None of the participants were able to successfully complete the exchange of the SGA for the ETT with the AAG. In the fiber optic guided intubation group, the rate of successful exchange was significantly higher with ILTS-D (84.6%) compared with AAG (61.5%) (P = 0.041).Conclusion:The ILTS-D successfully performs in an airway mannequin with higher success rate and shorter time for blindly establishing an airway with an ETT using the SGA as a conduit, compared with AAG. Further clinical trials are warranted.

A new second-generation supraglottic airway device (Ambu® AuraGain•) versus intubating laryngeal mask airway as conduits for blind intubation - A prospective, randomised trial.

Background and Aims:The Ambu® AuraGain• is a new single-use supraglottic airway device with gastric channel, designed to facilitate intubation. The study aimed to assess the success rates of proper placement and intubation using Ambu® AuraGain• compared with intubating laryngeal mask airway (ILMA).Methods:One hundred and twenty patients (18–60 years) were enrolled into this prospective, randomised, comparative study. After inducing general anaesthesia, appropriate size ILMA (group I)/Ambu® AuraGain• (group A) was placed as per the manufacturer's recommendations and correct placement was confirmed. Appropriate size endotracheal tube was passed through the device. The success rate of insertion and intubation, number of attempts, Cormack–Lehane grading before insertion and haemodynamics were recorded. Data were analysed using Mantel–Haenszel Chi-square test, Student's t-test and Fisher's exact test.Results:Demographic and airway parameters were uniformly distributed in both the groups. The success rate for insertion was 100% in both devices. The success rate for intubation was 96.6% (58/60) in group I and 36.6% in group A (P < 0.001). In group I, patients with mean thyromental distance >7.62 ± 0.75 cm had higher successful intubation compared with patients with mean thyromental distance <5.25 ± 0.35 cm (P = 0.014). Cormack–Lehane grading did not correlate with intubation attempts or success rate in group I (P = 0.45), whereas in group A the rate of successful blind intubation with Cormack–Lehane grade 1 was 50% (19/38).Conclusion:Both devices have 100% insertion success, though Ambu® AuraGain• has lower success rate for facilitating intubation compared with ILMA.

Comparative evaluation of Ambu Aura-i and Fastrach™ intubating laryngeal mask airway for tracheal intubation: A randomized controlled trial.

Background and aims:Ambu Aura-i was compared with Fastrach™ (FT)-laryngeal mask airway (LMA) as a conduit for tracheal intubation.Material and Methods:A hundred consenting patients were randomly allocated into two groups of 50 patients each in a prospective randomized study. Standard anesthesia technique was used for all patients and FT-LMA or Ambu Aura-i was selected. After insertion of airway device, the cuff was inflated and ventilation was attempted. Once satisfactory ventilation was achieved, with or without maneuvers, a fiberoptic scoring for glottis view was noted. A polyvinylchloride (PVC) tracheal tube of appropriate size was inserted through the airway device as per procedure. If no resistance was felt while advancing the tracheal tube, it was fully inserted into the device and tracheal tube cuff was inflated. The device was removed and tracheal tube was left in situ. If the first attempt failed during tracheal tube insertion, the recommended maneuvers were used. A maximum of three attempts were allowed for intubation. First attempt for tracheal intubation attempt was a blind, second attempt was made with maneuver. If second attempt of intubation was unsuccessful, fiberoptic-guided intubation was performed as a third attempt. When tracheal intubation was unsuccessful, it was performed by direct laryngoscopy and considered as failed intubation. Rest of the anesthesia management was as per the discretion of attending anesthesiologists. The success rate of device insertion, fiberoptic score of glottis view, tracheal intubation via FT-LMA or Aura-i and time were recorded.Results:Both FT-LMA and Aura-i were successfully placed within two attempts. The success rate of blind intubation was 92% in FT-LMA and 76% in Aura-i (P < 0.01). Time taken for tracheal intubation at first attempt was lesser in group FT-LMA and Aura-i, respectively (P < 0.01). Fiberoptic-guided intubation success rate was higher with Aura-i than with FT-LMA.Conclusions:FT-LMA had a higher success rate in facilitating blind tracheal intubation compared with Ambu Aura-i.

Methods of naso intestinal tube placement in 9 patients with severe brain injury accompanied by gastric retention

Objective The causes of unsuccessful nasointestinal tube placement in 9 patients with severe brain injury and gastric retention were analyzed and corrected. Methods The 9 cases of unsuccessful nasointestinal tube placement were analyzed from the aspects of disease, sedative drug use, mechanical ventilation, weakened bowel sounds and so on. Blind intubation was used to correct the defect, and the depth and time consumed of blind intubation and ultrasonic catheterization were compared. Results All 9 patients had gastric emptying disorders, decreased gastrointestinal peristalsis, and increased gastric residue, which affected the entrance of the catheter to the pylorus. Among them, 5 patients were given 3 or more sedative drugs in the state of drug sedation, and 2 patients had gastric emptying disorder due to the location of the disease damage. Therefore, ultrasound-guided nasointestinal tube placement was unsuccessful. Finally the 9 patients are successful to be inserted nasointestinal tubes by the blind placement plus air injection method. The average time of blind intubation was (28.89±13.80) min, which was lower than that of ultrasonic catheterization (84.44±20.07) min, and the difference was statistically significant (t=6.842, P<0.01) . Conclusions The failure of ultrasound-guided nasointestinal tube placement in patients with severe brain injury and gastric retention is related to the severity of the patient, the use of sedatives, mechanical ventilation, gastric retention and other causes of gastrointestinal peristalsis weakened or disappeared. Clinical nurses are required to give accurate assessment. Patients with severe brain injury and massive gastric retention are advised to use the blind placement plus air injection method for nasointestinal tube placement. In the case of ultrasound-guided nasointestinal tube placement, gastric motility drugs need to be used in advance. Key words: Nursing care; Brain injury; Gastroparesis; Nasointestinal tube placement; Ultrasound-guided; Blind placement plus air injection

Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand

Background:Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation.Methods:The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression.Results:Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35–49), compared with Air-Q (21 seconds, 18–32) and I-Gel (19 seconds, 17–27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001).Conclusions:Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.

Blind intubation via iGEL laryngeal mask performed by novice physicians: A randomized, crossover, manikin trial

Blind intubation via iGEL laryngeal mask performed by novice physicians: A randomized, crossover, manikin trial

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

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.