What is the scope for new devices for tracheal intubation?

In this randomized, crossover study, 54 paramedics performed tracheal intubation using an Airtraq^®, an airway scope (AWS), and a Macintosh laryngoscope.

Three different prehospital scenarios were assessed: ‘standard airway’ with the mannequin placed on the floor; ‘difficult airway’ with the mannequin on the floor with a semi-rigid collar and the inside of the tongue padded with gauze to simulate swelling (Grade III Cormack and Lehane view); and ‘forward-facing intubation’ with the mannequin sitting upright on a chair.

The order of scenarios remained constant for all participants but the order of use of the devices was randomized.

The ‘standard airway’ scenario showed no statistically significant differences between the devices in overall success rate, time to successful intubation or success within 30 seconds.

The ‘difficult intubation’ scenario highlighted the greatest differences with Airtraq^® and AWS enabling statistically shorter times to intubation, and higher rates of successful intubation (Airtraq^® 90%; AWS 100%) compared to the Macintosh (63%).

The ‘forward-facing’ scenario showed no significant differences in overall success rate but using Airtraq^® resulted in the longest time to intubation (median: Airtraq^®=26s; Macintosh=22s; AWS=19s). Overall, 43 participants said they preferred the AWS; 9 liked Airtraq^®, and 2 favoured the Macintosh.