Comparison of fibre-optic-guided endotracheal intubation through a supraglottic airway device versus hyperangulated video laryngoscopy by emergency physicians: A randomised controlled study in cadavers

Background: After failed endotracheal intubation, using direct laryngoscopy, rescued using a supraglottic airway device, the choice of subsequent method to secure a definitive airway is not clearly determined. Objective: The aim of this study was to compare the time to intubation using a fibre-optic airway scope, to guide an endotracheal tube through the supraglottic airway device, with a more conventional approach using a hyperangulated video laryngoscope. Methods: A single-centre randomised controlled trial was undertaken. The population studied were emergency physicians working in an adult major trauma centre. The intervention was intubation through a supraglottic airway device guided by a fibre-optic airway scope. The comparison was intubation using a hyperangulated video laryngoscope. The primary outcome was time to intubation. The trial was registered with ANZCTR.org.au (ACTRN12621000018819). Results: Four emergency physicians completed intubations using both of the two airway devices on four cadavers for a total of 32 experiments. The mean time to intubation was 14.0 s (95% confidence interval = 11.1–16.8) in the hyperangulated video laryngoscope group compared with 29.2 s (95% confidence interval = 20.7–37.7) in the fibre-optic airway scope group; a difference of 15.2 s (95% confidence interval = 8.7–21.7, p < 0.001). All intubations were completed within 2 min, and there were no equipment failures or evidence of airway trauma. Conclusion: Successful intubation of the trachea without airway trauma by emergency physicians in cadavers is achievable by either fibre-optic airway scope via a supraglottic airway device or hyperangulated video laryngoscope. Hyperangulated video laryngoscope was statistically but arguably not clinically significantly faster than fibre-optic airway scope via supraglottic airway device.

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Randomised controlled trial in cadavers investigating methods for intubation via a supraglottic airway device: Comparison of flexible airway scope guided versus a retrograde technique

Emergency Medicine Australasia ◽

10.1111/1742-6723.13908 ◽

2021 ◽

Author(s):

Christopher J Groombridge ◽

Amit Maini ◽

Cecil Johnny ◽

David McCreary ◽

Yesul Kim ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Airway Scope ◽

Randomised Controlled ◽

Retrograde Technique

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Does prewarming the i-gel supraglottic airway device fit the larynx better compared to keeping it at room temperature for non-paralysed, sedated patients: a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2014-006653 ◽

2015 ◽

Vol 5 (1) ◽

pp. e006653-e006653 ◽

Cited By ~ 2

Author(s):

N. Komasawa ◽

I. Nishihara ◽

S. Tatsumi ◽

T. Minami

Keyword(s):

Randomised Controlled Trial ◽

Room Temperature ◽

Controlled Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Randomised Controlled

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Design and implementation of the AIRWAYS-2 trial: A multi-centre cluster randomised controlled trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2016.09.016 ◽

2016 ◽

Vol 109 ◽

pp. 25-32 ◽

Cited By ~ 24

Author(s):

Jodi Taylor ◽

Sarah Black ◽

Stephen J. Brett ◽

Kim Kirby ◽

Jerry P. Nolan ◽

...

Keyword(s):

Cardiac Arrest ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Design And Implementation ◽

Cluster Randomised ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

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Comparison of endoscopic endotracheal intubation and the v-gel supraglottic airway device for spontaneously ventilating New Zealand white rabbits undergoing ovariohysterectomy

Veterinary Record ◽

10.1136/vr.105746 ◽

2020 ◽

Vol 187 (10) ◽

pp. e84-e84

Author(s):

Jessica Comolli ◽

Rodney Schnellbacher ◽

Hugues Beaufrere ◽

Uriel Blas-Machado ◽

Jane Quandt ◽

...

Keyword(s):

New Zealand ◽

Endotracheal Intubation ◽

Airway Device ◽

Supraglottic Airway ◽

Controlled Study ◽

Positive Pressure ◽

Supraglottic Airway Device ◽

Arterial Blood ◽

Airway Trauma ◽

New Zealand White Rabbits

BackgroundDue to the technical difficulties with endotracheal intubation of rabbits, a prospective, randomised, controlled study was performed to compare a rabbit-specific supraglottic airway device (SGAD), the v-gel, with endoscopic endotracheal intubation (EEI) in spontaneously breathing rabbits undergoing ovariohysterectomy.MethodsFourteen adult female New Zealand white rabbits were randomly allocated to one of two groups based on the method of airway establishment: EEI or v-gel SGAD. Anaesthesia was induced with ketamine and xylazine and maintained using isoflurane in 100 per cent oxygen. Comparisons were made between groups based on placement time of endotracheal tube/SGAD, number of attempts and adjustments, the necessity to increase isoflurane concentrations to maintain a surgical plane of anaesthesia, arterial blood gas values, gross laryngeal evaluation, and laryngotracheal histopathology.ResultsBoth techniques resulted in elevated arterial pCO2 levels, but the v-gel was associated with more elevated pCO2 in comparison with EEI (P=0.045). Airway trauma was histologically present but clinically negligible in both groups, with no statistically significant differences observed between techniques (P>0.05). Placement time of the v-gel was significantly faster (P=0.003) and required less technical skill than EEI, but was more easily displaced when changing the animal’s position (P=0.004).ConclusionThe v-gel is a practical alternative to EEI for securing the airway of healthy spontaneously ventilating rabbits, provided a capnograph is utilised to ensure continuous placement. Both airway techniques appear safe and effective with few complications, as long as intermittent positive pressure ventilation can be employed to correct hypercapnia.

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