title: Use of the Airtraq laryngoscope for emergency intubation in the prehospital setting: a randomized control trial.
abstract: OBJECTIVE
  The optical Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) has been shown to have advantages when compared with direct laryngoscopy in difficult airway patients. Furthermore, it has been suggested that it is easy to use and handle even for inexperienced advanced life support providers. As such, we sought to assess whether the Airtraq may be a reliable alternative to conventional intubation when used in the prehospital setting.
  
  
  METHODS
  Prospective, randomized control trial in emergency patients requiring endotracheal intubation provided by anesthesiologists or emergency physicians responding with an emergency medical service helicopter or ground unit associated with the Department of Anesthesiology, General Hospital, Wiener Neustadt, Austria.
  
  
  RESULTS
  During the 18-month study period, 212 patients were enrolled. When the Airtraq was used as first-line airway device (n=106) vs. direct laryngoscopy (n=106), success rate was 47% vs. 99%, respectively (p<.001). Reasons for failed Airtraq intubation were related to the fiber-optic characteristic of this device (i.e., impaired sight due to blood and vomitus, n=11) or to assumed handling problems (i.e., cuff damage, tube misplacement, or inappropriate visualization of the glottis, n=24). In 54 of 56 patients where Airtraq intubation failed, direct laryngoscopy was successful on the first attempt; in the remaining two and in one additional case of failed direct laryngoscopy, the airway was finally secured employing the Fastrach laryngeal mask. There was no correlation between success rates and body mass index, age, indication for airway management, emergency medical service unit, or experience of the physicians.
  
  
  CONCLUSIONS
  Based on these results, the use of the Airtraq laryngoscope as a primary airway device cannot be recommended in the prehospital setting without significant clinical experience obtained in the operation room. We conclude that the clinical learning process of the Airtraq laryngoscope is much longer than reported in the anesthesia literature.
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital, Wiener Neustadt, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Trimmel
authors.forename: Janett
authors.initials: J
authors.lastname: Kreutziger
authors.forename: Georg
authors.initials: G
authors.lastname: Fertsak
authors.forename: Robert
authors.initials: R
authors.lastname: Fitzka
authors.forename: Markus
authors.initials: M
authors.lastname: Dittrich
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Voelckel
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D004632:Emergency Medical Services / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies