The performance of rigid scopes for tracheal intubation: a randomised, controlled trial in patients with a simulated difficult airway

Kleine‐Brueggeney, Maren; Greif, Robert; Urwyler, Natalie; Wirthmüller, Beat; Theiler, Lorenz

doi:10.1111/anae.13626

Cited by 15 publications

(13 citation statements)

References 33 publications

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“…It was performed at the University Hospital in Bern, Switzerland, following CONSORT guidelines. It was part of a research project about the two rigid scopes including the presented learning of intubation in patients with normal airways, and an assessment of the performance of the scopes in patients with a simulated difficult airway, which was previously published [1]. Ethical approval was provided by the local ethics committee (Cantonal Ethics Committee, Bern University Hospital, Bern, Switzerland, Chairperson Dr. Christian Seiler; approval number KEK 247/09, 22/02/ 2010, amendments approved on 31/05/2012 and 25/06/ 2012).…”

Section: Methodsmentioning

confidence: 99%

“…Success rates of over 80% have been described for the Bonfils in a simulated difficult airway setting [4]. Similarly, SensaScope and Bonfils both achieved overall intubation success rates of 88-89% in a randomized controlled trial in patients with a simulated difficult airway [1].…”

Section: Introductionmentioning

confidence: 92%

“…Rigid intubation scopes are used for management of predicted and unpredicted difficult airways [1][2][3][4]. Compared with flexible optical scopes, rigid scopes provide faster setup, a more durable lifespan, and an easy cleaning process [5].…”

Section: Introductionmentioning

confidence: 99%

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The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations

et al. 2020

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Background Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established. Methods This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per physician) in adult patients without predictors of a difficult airway under general anaesthesia. According to randomisation, physicians intubated the patient’s trachea with either the Bonfils or the SensaScope. A maximum of three intubation attempts was allowed. Primary outcome was overall time to successful intubation. Secondary outcome parameters included first attempt success, first attempt success within 60 s, failures and adverse events. Results A clear learning effect was demonstrated: Over 20 trials, intubations became 2.5-times quicker and first attempt intubation success probability increased by 21–28 percentage points. Fourteen and 20 trials were needed with the Bonfils and the SensaScope, respectively, to reach a 90% first attempt success probability. Intubation times were 23% longer (geometric mean ratio 1.23, 95% confidence interval 1.12–1.36, p < 0.001) and first attempt success was less likely (odds ratio 0.64, 95% confidence interval 0.45–0.92, p = 0.016) with the SensaScope. Consultants showed a tendency for a better first attempt success compared to registrars. Overall, 23 intubations (10 Bonfils, 13 SensaScope) failed. Adverse events were rare and did not differ between devices. Conclusions A clear learning effect was demonstrated for both rigid scopes. Fourteen intubations with the Bonfils and 20 intubations with the SensaScope were required to reach a 90% first attempt success probability. Learning of the technique seemed more complex with the SensaScope compared to the Bonfils. Trial registration Current Controlled Trials, ISRCTN14429285. Registered 28 September 2011, retrospectively registered.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

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The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations

et al. 2020

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“…One such study is published in this month's issue of Anaesthesia . Kleine‐Brueggeney et al randomly allocated patients to two different models of rigid laryngoscope (Bonfils and SensaScope ® ) in a simulated difficult airway situation. Whilst its value as a clinical study is undeniable, this must be balanced with careful consideration of the ethical acceptability of simulating a difficult airway in patients for the sole purpose of research.…”

Section: Patients Not Manikinsmentioning

confidence: 99%

Man vs. manikin revisited - the ethical boundaries of simulating difficult airways in patients

Ward

Irwin

2016

Anaesthesia

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“…There have been a number of patient studies published where difficult tracheal intubation has been simulated in an otherwise ‘normal’ airway . The ethical acceptability of this has been questioned, leading to the development of consensus guidelines on airway research ethics (CARE) , which seek to restrict the number of attempts at securing the airway, limiting participants to only ASA status 1–2 and excluding patients with potentially difficult airways.…”

Section: Introductionmentioning

confidence: 99%

Airway management research: a systematic review

et al. 2018

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Recent controversy regarding the ethics of conducting airway research in patients led to disagreements concerning the value and frequency of manikin-based investigation. However, no formal examination of the methodology of airway research has been undertaken. We, therefore, performed a systematic bibliometric review of airway management research to describe the conduct, quantify the subjects (patient vs. manikin vs. other), assess the reported outcomes and map global trends. We retrieved 1505 relevant studies published between 2006 and 2017, together recruiting 359,648 subjects, of which 341,233 were patients, the remaining being volunteers or subjects managing manikins, human cadavers, animals or bench models. There were 701 randomised controlled clinical trials (46.6%), 83 non-randomised experimental clinical trials (5.5%), 298 observational studies (19.8%) and 423 non-patient studies (28.1%). A total of 1082 studies (71.9%) were patient studies and 322 were manikin studies (21.4%). The total annual number of airway management studies increased over time, as did the annual number of patient studies, but there was no significant increase in the annual number of manikin studies over time. Of the patient studies, subject baseline characteristics were most likely to be ASA status 1-2 (n = 531, 49.1%), populations were most often elective surgical patients (n = 918, 84.8%) and the most common interventions studied were tracheal intubation (n = 820, 54.4%) or supraglottic airway device insertion (n = 257, 17.1%). There was a total of 77 different primary outcomes used in the included studies, the most commonly reported being success rate and procedure time. By understanding how and what has been previously studied these data can be used to form the basis for future priority setting exercises, core outcome set development, and could inform strategy on the future directions of airway management research.

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The performance of rigid scopes for tracheal intubation: a randomised, controlled trial in patients with a simulated difficult airway

Cited by 15 publications

References 33 publications

The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations

The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations

Man vs. manikin revisited - the ethical boundaries of simulating difficult airways in patients

Airway management research: a systematic review

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