Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions

Abstract

Objectives: Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions. Methods: Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs. Results: Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs. Conclusion: The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations. RÉ SUMÉObjectifs: Le tube endotraché al est considé ré comme le moyen par excellence de protection des voies aé riennes. Cependant, il existe d'autres dispositifs de protection des voies aé riennes qui peuvent ê tre utilisé s par du personnel non formé ou des personnes ayant peu d'expé rience ou encore dans des cas où l'intubation endotraché ale n'est pas possible. L'é tude avait pour buts principaux d'é valuer le taux de ré ussite de la mise en place et le temps de pose de diffé rents dispositifs supraglottiques et de dé terminer si ces dispositifs pouvaient ê tre installé s correctement dans des situations d'urgence simulé es. Mé thodes: Cinquante é tudiants en mé decine ont utilisé un simulateur de voies aé riennes (Laerdal SimMan 3G) pour é valuer le taux de ré ussite de la mise en place et le temps de pose de sept dispositifs supraglottiques diffé rents, dans des é tats physiologiques et pathologiques simulé s, en deux sé ances. Ré sultats: Il a é té possible de poser tous les dispositifs sans problè me, mais seuls les tubes Combitube et EasyTube ont pu ê tre mis en place dans des é tats simulé s de trismus, de mobilité ré duite de la colonne cervicale, ou d'association d'é tats pathologiques tels que le trismus et une mobilité ré duite de la colonne cervicale ou le trismus et un oedè me de la langue. Le temps de mise en place d'autres dispositifs: le LMA Unique, le Fastrach, et l'I-Gel, é tait passablement plus long,...

Comparison of the i-gel and other supraglottic airways in adult manikin studies

“…[1,4,11,13,14,21–29] All studies were randomized crossover trials except 1 with parallel design. [21] The included articles contained several comparisons between the i-gel and other supraglottic airways as follows: 4 comparisons with the LMA Classic (LMA North America, Inc., San Diego, USA), [11,22,25,29] 5 with the LMA Fastrach (Laryngeal Mask, Prodol Meditec, Spain), [13,14,24,27,28] 3 with the LMA Proseal (LMA North America, Inc., San Diego, USA), [1,14,23] 3 with the LMA Supreme, [13,23,24] 5 with the LMA Unique (LMA North America, Inc., San Diego, USA), [1,4,14,23,24] 7 with the laryngeal tube (King-LT-D, VBM, Sulz, Germany), [1,4,13,14,21,22,24] 5 with the Combitube (Covidien, Mansfield, MA, USA), [1,4,13,14,24] 4 with the EasyTube (Teleflexmedical Ruesch, Research Triangle Park, NC, USA), [1,4,13,24] 1 with the SoftSeal (Smiths Medical International Ltd, Ashford, Kent, UK), [26] 1 with the AuraOnce (Ambu, Ballerup, Denmark), [26] 1 with the aura-i, [27] and 1 with the air-Q (Cookgas LLC, Mercury Medical, USA). [27] Characteristics of the included articles are summarized in Table 1 .…”

“…[1,13,23,24] Four studies included insertions of devices under difficult circumstances, such as while wearing protective equipment and applying a neck collar and pathologic airway conditions. [14,24,25,29] In this meta-analysis, insertion variables investigated at the second assessment or under difficult circumstances were analyzed additionally. Robak et al's [24] study assessed device insertion under simulated physiologic and pathologic airway conditions at the initial and second assessments.…”

“…[14,24,25,29] In this meta-analysis, insertion variables investigated at the second assessment or under difficult circumstances were analyzed additionally. Robak et al's [24] study assessed device insertion under simulated physiologic and pathologic airway conditions at the initial and second assessments. However, the insertion success rate under physiologic conditions was only included in this analysis as its exact values investigated under pathologic airway conditions were not stated at both of the assessments.…”

“…In all enrolled studies, performance and detection bias regarding the blinding of participants and assessors was graded as high risk. Conflicts of interest were reported in 6 trials, [1,4,13,22–24] and regarded as other bias. [30] …”

What were the Reviewers Thinking?

“…To the editor: It seemed a curious choice to publish the peer-reviewed article ''Feasibility and Speed of Insertion of Seven Supraglottic Airway Devices under Simulated Airway Conditions'' by Robak and colleagues 1 in the November 2012 issue of the CJEM. The article purports to compare the speed of insertion of seven different supraglottic airway devices by inexperienced medical students using one type of airway manikin.…”