Comparison of intubating supraglottic airway devices in adult airway training manikin

Introduction and aim: Supraglottic airway devices (SADs) are useful in cases of failed or difficult airway. Also some of the devices can use for blind endotracheal intubation. In this study, we aimed to compare blind intubation with LMA Fastrach, Ambu Aura – i or Cookgas Air – Q by inexperienced practitioners. Material and Methods: This study was designed as a randomized, cross-over manikin study. Four weeks after the standart training on SAD application to 36 inexperienced practitioners who were students in the last year of medical school, success of three different SADs (LMA Fastrach®, Ambu Aura – i® and Cookgas Air – Q®) on an adult airway manikin were compared. Participants were divided into groups by randomization in order to application SADs and success and duration of application were evaluated in three different stages (first stage – 1A; placement of SADs, second stage – 2A; intubation through SADs; third stage – 3A; removal of SADs from ETT to ensure permanent intubation). Results: Participants' female/male ratio was 16/20 (44.4%/55.6%) and mean age was 24 (23 – 28). Application successes of SADs were evaluated, ILMA and Air – Q were successfully applied by all 36 participants and 30 participants (83.3%) were able to succesfully applied Aura – i (p<0.05). SADs successful application time (1A+2A+3A) for ILMA, Aura – i and Air – Q were 54.4 sec, 55.8 sec, 58.7 sec respectively and there was no significant difference between them (p>0.05). There was no significant difference between the three SADs applications in the first stage – 1A (p>0.05). The median of successful 1A periods; ILMA, Aura – i and Air – Q were 13 sec, 12.4 sec and 14.4 sec respectively. At this stage, there was no significant difference between ILMA and Aura-i (p>0.05), whereas both SADs were applied significantly faster than Air – Q (p<0.05). When the second stage – 2A results were compared, ILMA and Air – Q were more successful than Aura – i (p<0.05). The median of successful 2A durations for ILMA, Aura – i and Air – Q were 18 sec, 17.3 sec and 17.4 sec (p>0.05) and placement of SAD followed by intubation through SAD (1A+2A) durations are 27.7 sec, 27 sec and 28.7 sec respectively (p>0.05). When practitioners were asked which SAD to prefer for further cases, 16 practitoners (44.4%) preferred ILMA, eight practitioners (22.2%) preferred Aura – i and 12 practitioners (33.3%) preferred Air – Q. ILMA and Air – Q were found to be more preferred than Aura – i (p<0.05), but there was no significant difference between ILMA and Air – Q (p>0.05). When the satisfaction of the three SADs were evaluated according to the five-point Likert scale, the participants scored significantly higher Air – Q (p<0.05). Air – Q (n=18, 50%) had the highest satisfaction score (5) and Aura – i (n=5, 13.9%) had the lowest score (1). Conclusion: ILMA, Air – Q and Aura – i can be used safely in advanced airway management by inexperienced practitioners. Placement time of SADs were longer with Air – Q then ILMA and Aura – i. If permanent intubation goaled after SAD placement, ILMA and Air – Q which are allowing tracheal intubation through should be preferred. In terms of user satisfaction, ILMA and Air – Q are more successful than Aura – i. Keywords: supraglottic airway devices, manikin study, lma fastrach, ambu aura – i, cookgas air – q