title: A cadaver study comparing three fibreoptic-assisted techniques for converting a supraglottic airway to a cuffed tracheal tube.
abstract: After rescuing an airway with a supraglottic airway device, a method to convert it to a cuffed tracheal tube is often needed. The best method to do this has never been directly studied. We compared three techniques for conversion of a standard LMA®Unique airway to a cuffed endotracheal tube using a fibrescope. The primary endpoint was time to intubation, with secondary endpoints of success rate, perceived difficulty and preferred technique. We also investigated the relationship between level of training and prior training and experience with the techniques on the primary outcome. The mean (95% CI) time to intubation using a direct tracheal tube technique of 37 (31-42) s was significantly shorter than either the Aintree intubation catheter technique at 70 (60-80) s, or a guidewire technique at 126 (110-141) s (p < 0.001). Most (13/24) participants rated the tracheal tube as their preferred technique, while 11/24 preferred the Aintree technique. In terms of perceived difficulty, 23/24, 21/24 and 9/24 participants rated the tracheal tube technique, Aintree technique and guidewire technique, respectively, as either very easy or easy. There was no relationship between prior training, prior experience or level of training on time to completion of any of the techniques. We conclude the tracheal tube and Aintree techniques both provide a rapid and easy method for conversion of a supraglottic airway device to a cuffed tracheal tube. The guidewire technique cannot be recommended.
authors.affiliation: Northern Sydney Anaesthetic Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: B L
authors.initials: BL
authors.lastname: Olesnicky
authors.affiliation: Northern Sydney Anaesthetic Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Rehak
authors.affiliation: Northern Sydney Anaesthetic Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: W B
authors.initials: WB
authors.lastname: Bestic
authors.affiliation: Northern Sydney Anaesthetic Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: J T
authors.initials: JT
authors.lastname: Brock
authors.affiliation: Northern Sydney Anaesthetic Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Watterson
mesh_terms: D002102:Cadaver; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male
keywords: LMA: intubation guide; difficult airway algorithm; failed Intubation: treatment