Airway Management at Floor Level: A Comparison of Tracheal Intubation using the Macintosh and Airtraq Laryngoscopes

Abstract

Practitioners providing pre-hospital care during civilian practice and on military operations may be required to perform airway management and tracheal intubation at floor level. It has been shown that intubation using the Airtraq laryngoscope is easier to learn than standard Macintosh laryngoscopy. We hypothesised that the Airtraq would be easier to use and have shorter intubation times than Macintosh intubation. Sixty volunteers attending a medical conference with no prior Airtraq experience, who were skilled in pre-hospital Macintosh intubation, were recruited. Each was required to intubate an anatomically correct manikin at floor level using a Macintosh and Airtraq laryngoscope. The Airtraq was found to be superior in ease of use (VAS 30 mm, P < 0.001), had a shorter total intubation time (19.4seconds) and a higher intubation success rate (P = 0.012) than the Macintosh laryngoscope (VAS 50 mm, 20.4 seconds). Rotating the tracheal tube 90 degrees anticlockwise during loading into the guiding channel, made the Airtraq intubation easier (VAS 30 mm, P = 0.001) and faster (19.4 seconds, P < 0.001) than with standard orientation of the tube (VAS 40 mm, 25.3 seconds). Airtraq intubation may prove to be easier than Macintosh intubation, when utilised in the clinical pre-hospital setting, though randomised controlled clinical trials are required to confirm this.

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

“…On the other hand, as the students expressed in the questionnaires, they thought that the use of the Macintosh was the most difficult of all, and it also led to higher complication expectations compared to the others. Also this was in line with previous studies, where Airtraq was the most preferred instrument by the users in comparison with the Macintosh laryngoscope (17,18). In a comparison for anaesthetized adult patients with Manual in Line Axial Stabilization, the Airtraq group had a significantly longer duration for both intubation and laryngoscopy, although the Airtraq provided an equal success rate of intubation as the Macintosh laryngoscope (19).…”

A paramedic study comparing the use of the Airtraq®, Airway Scope and Macintosh laryngoscopes in simulated prehospital airway scenarios*

“…Airtraqguided tracheal intubation was found to be faster and had lower rates of oesophageal intubation when compared with use of the Macintosh laryngoscope in a model of difficult intubation [18] and when managing the airway at floor level [19]. Tong et al [19] found significant differences in success rate between the Airtraq (tube mounted with 90°anti-clockwise rotation) and Macintosh laryngoscopes in a standard manikin at floor level. The use of the Airway Scope, in a study designed to simulate restricted access to the airway, resulted in a shorter time to intubate and ventilate compared with the Macintosh laryngoscope [26].…”

“…The most frequently stated reasons for this preference were quality of view and ease of use. Other studies have cited operator preference for either the Airtraq [18,19] or the Airway Scope [11] over the Macintosh laryngoscope. This is, however, the first study comparing the two indirect laryngoscopes when used by paramedics.…”

“…Although a patient should ideally be moved on to a trolley before intubation, this is often not possible, especially when cardiopulmonary resuscitation has commenced or due to patient entrapment [23]. A number of patient [25] and manikin studies [18,19,26] have evaluated the ease of use of videolaryngoscopes in difficult circumstances. Airtraqguided tracheal intubation was found to be faster and had lower rates of oesophageal intubation when compared with use of the Macintosh laryngoscope in a model of difficult intubation [18] and when managing the airway at floor level [19].…”

“…A number of patient [25] and manikin studies [18,19,26] have evaluated the ease of use of videolaryngoscopes in difficult circumstances. Airtraqguided tracheal intubation was found to be faster and had lower rates of oesophageal intubation when compared with use of the Macintosh laryngoscope in a model of difficult intubation [18] and when managing the airway at floor level [19]. Tong et al [19] found significant differences in success rate between the Airtraq (tube mounted with 90°anti-clockwise rotation) and Macintosh laryngoscopes in a standard manikin at floor level.…”