Airtraq laryngoscope versus conventional Macintosh laryngoscope: a systematic review and meta-analysis

Abstract

SummaryThe Airtraq laryngoscope is a single-use laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways. The aim of this systematic review and meta-analysis was to compare the Airtraq with the conventional Macintosh laryngoscope. Data were retrieved from Medline, Embase, the Cochrane register of controlled trials, and by a manual search of bibliographies. Twelve randomised controlled trials (published between 2006 and 2011) including 1061 patients met the inclusion criteria. The Airtraq reduced intubation time significantly (mean difference )15 s; 95% CI )25 to )4 s, p < 0.00001) used by both experienced anaesthetists and novices, and it increased the first attempt success rate only in novices (relative risk 1.25; 95% CI 1.05-1.49, p = 0.07). The incidence of oesophageal intubation (relative risk 0.12; 95% CI 0.03-0.48, p < 0.05) was significantly reduced by the Airtraq. We conclude that the Airtraq laryngoscope facilitates a more rapid and accurate intubation, especially when used by novices. The Airtraq laryngoscope (Prodol Ltd, Vizcaya, Spain) is a single-use optical laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways [1,2]. It has a light source and a guiding channel in which to place the tracheal tube and also a heating system to prevent misting of the viewfinder. Owing to the special design of the optical components and the curvature of the rigid blade, the Airtraq allows viewing the glottic without alignment of the oral-pharyngeal-tracheal axes.Several randomised controlled trials have compared the Airtraq with the Macintosh laryngoscope, but the results were conflicting. To provide greater clarity about outcomes, we carried out a systematic review and meta-analysis. We pooled the results of the intubation time, the first attempt success rate, the incidence of complications and the incidence of oesophageal intubation. A subgroup analysis was carried out to investigate heterogeneity, and a sensitivity analysis was conducted to evaluate the degree of certainty of the result. MethodsTwo reviewers (Y.L and H.J) independently carried out a comprehensive search (last update 31 March 2011) of Medline (Pubmed), Embase and the Cochrane register of controlled trials, searching for randomised controlled trials that compared the Airtraq with the Macintosh laryngoscope. The search strategy consisted of a combination of free text words: 'Airtraq' and 'Macintosh'. There were no restrictions concerning the language of the article or publication type.We included all randomised controlled trials comparing the Airtraq with the Macintosh laryngoscope. We excluded manikin studies, case reports, reviews and crossover or non-randomised controlled trials, identified as such after reading the title and abstract.

Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study

“…Thus, not only is the number of manoeuvres decreased but also less effort is required for intubation. In other words, there are less haemodynamic changes in the clinic (28,29). The results of the present study may be adapted to clinical practices excluding the cases in which the glottic view is extremely restricted due to blood or secretion.…”

Comparison between the Airtraq, X-Lite, and direct laryngoscopes for thyroid surgery: a randomized clinical trial

“…29,30 Une méta-analyse confirme les résultats de ces études en montrant une réduction du temps de l'intubation au profit de l'Airtraq et une réduction de l'incidence du risque de l'intubation oesophagienne. 31 Les autres avantages de l'Airtraq sont le meilleur apprentissage de l'intubation, 32,33 la réduction du mouvement du rachis cervical 34 et la diminution du risque infectieux. 35 Chez nos patients, nous avons choisi comme critère de jugement principal le temps d'intubation.…”

Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success

“…Laringoskopik görüntüleme ile entübasyon başarısı farklı kavramlardır. Bizim çalışmamız da dahil olmak üzere literatürdeki çalışmaların hemen tamamı entübasyon başarısı olarak laringoskopik görünüm sınıflamasını temel almışlardır (1)(2)(3)(4)(5)(6)(7)(8). Ancak laringoskopik görüntüleme şartlarının iyileş-mesinin her zaman daha yüksek bir entübasyon başarısı ile eşleşmediği de unutulmamalıdır (3).…”

“…Bu durum bir taraftan entübasyon süresini uzatırken bir taraftan da kolaylaştırıcı manevra kullanımını gerektirdi. 2006-2011 yılları arasında Airtraq laringoskop ile Macintosh laringoskopu karşılaştıran 12 randomize kontrollü çalışmanın bulgularını irdeleyen meta-analizde, Airtraq laringoskop ile entübasyon süresi ve özofagus entübasyon riskinin belirgin oranda azaldığı sonucuna varılmıştır (6). Ancak bizim çalışmamızda, yine literatürde yer alan bazı çalışmalarda da (7) olduğu gibi, Airtraq laringoskopi grubunda entübasyon süreleri bir miktar uzamakla birlikte gruplar arası istatistiksel olarak anlamlı bir fark izlenmedi.…”