Background and goal of study: Airway rescue techniques are of vital importance in cases of cannot intubate cannot oxygenate. Even experienced anaesthetists encounter frequent problems with these techniques, sometimes with devastating consequences (1). Therefore there is a clinical need for easier and faster methods. We have recently reported our results of the camera in tube intubation (CITI) technique, tracheal intubation with a VivaSightTM tube through a supraglottic device (2). Aim of the current study was to compare this novel technique with direct laryngoscopy.
Materials and Methods: A Laerdal SimManTM manikin was placed in left- and subsequently in right lateral tilt to simulate a difficult intubation position. Two 4th year registrars, two experienced consultants and one experienced nurse anaesthetist were asked to intubate first conventionally with a laryngoscope Macintosh blade 3 and next with a VivaSight 7.0 via an i-gel 5.0. Times were recorded until visual confirmation of correct tube placement. For both techniques the same VivaSight tube was used. Maximal time for intubation was set at 40 seconds. The intubation times were compared with a Mann-Whitney test (IBM SPSS 20.0). A p value < 0.05 was considered statistically significant. Review Board approval was obtained.
Results and Discussion: A total of 120 intubations (60 with a laryngoscope and 60 with the CITI i-gel technique) were performed. With laryngoscopy 56 attempts (93%) were successful within 40 s. With the CITI i-gel technique we observed the same overall success rate (93%). The mean (SD) time to intubation with a laryngoscope was 10.1 (4.2) s and with the CITI i-gel combination 10.6 (4.1) s (p=0.243). In contrast to the consultants and nurse anaesthetist, the registrars had a higher success rate using the CITI i-gel technique (100%) than with the conventional method (83%). Their intubation times were also faster using this technique, 10.3 (3.9) s vs 12.8 (4.9) s (p=0.041). We believe this novel technique may proof promising for airway rescue, particularly for personnel with less airway management experience like registrars or paramedics.
Conclusion: Camera in tube intubation through an i-gel is a fast and easy technique for tracheal intubation of a manikin placed in a difficult intubation position. Clinical studies are needed.
1. Cook TM, Woodall N, Frerk C. Br J Anaesth. 2011;106:617-631
2. Huitink JM, Koopman EM, Bouwman RA, et al. Anaesthesia 2013;68:74-78