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 (TM), Airtraq (TM) laryngoscope, and GlideScope (TM) 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 (TM), GlideScope (TM), and Airtraq (TM) 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 (TM) (100%), when compared with that of the GlideScope (TM) (70%, P < 0.05) and LMA Fastrach (TM) (83%, P < 0.05). Face-to-face tracheal intubation was less difficult (visual analogue scale: 0-100) with the Airtraq (TM) 11 (6) when compared with the GlideScope (TM) [33 (14) s, P < 0.01)] and LMA Fastrach (TM) [22 (21) s, P < 0.01]. The face-to-face tracheal intubation time was shorter with the Airtraq (TM) 14 (6) s than with the GlideScope (TM) [27 (18) s, P < 0.01] and Fastrach (TM) [28 (10) s, P < 0.01]. Conclusions. The Airtraq (TM) laryngoscope was superior to both the GlideScope (TM) and LMA Fastrach (TM) during simulated face-to-face difficult tracheal intubation.