Simulating face-to-face tracheal intubation of a trapped patient: a randomized comparison of the LMA Fastrach™, the GlideScope™, and the Airtraq™ laryngoscope.

BACKGROUND: We undertook a prospective randomized comparison of the LMA Fastrach™, Airtraq™ laryngoscope, and GlideScope™ used for face-to-face tracheal intubation simulated to mimic an entrapped patient.

METHODS: Thirty senior emergency medicine physicians were trained in the use of the LMA Fastrach™, GlideScope™, and Airtraq™ laryngoscope with a standard airway trainer manikin (control). Participants were then asked to perform tracheal intubation in two difficult situations simulated on a difficult airway management manikin wearing a cervical collar. In Situation 1, the manikin was in the supine position with a difficult airway caused by stiffening the cervical spine. In Situation 2, the manikin was positioned to simulate face-to-face tracheal intubation. We measured intubation times, success rates for tracheal intubation, and the difficulty of tracheal intubation. Values are means (sd).

RESULTS: In control and Situation 1, tracheal intubation details were similar. In Situation 2, face-to-face tracheal intubation success rate was increased with the Airtraq™ (100%), when compared with that of the GlideScope™ (70%, P<0.05) and LMA Fastrach™ (83%, P<0.05). Face-to-face tracheal intubation was less difficult (visual analogue scale: 0-100) with the Airtraq™ 11 (6) when compared with the GlideScope™ [33 (14) s, P<0.01)] and LMA Fastrach™ [22 (21) s, P<0.01]. The face-to-face tracheal intubation time was shorter with the Airtraq™ 14 (6) s than with the GlideScope™ [27 (18) s, P<0.01] and Fastrach™ [28 (10) s, P<0.01].

CONCLUSIONS: The Airtraq™ laryngoscope was superior to both the GlideScope™ and LMA Fastrach™ during simulated face-to-face difficult tracheal intubation.