Comparison of endotracheal intubation and a new-generation supraglottic airway device in training of difficult airway: a manikin study

Objective: To compare the performance times and success rates of the classic Macintosh laryngoscope (CML) or video laryngoscope (VL) with endotracheal intubation (ETI) and second-generation supraglottic airway devices (SAD) in difficult airway management during cardiopulmonary resuscitation (CPR). Materials and methods: Classic Macintosh Laryngoscope (D1), C-Mac (R) videolaryngoscope (D2), Laryngeal Tube LTS-D (R) (D3), LMA Supreme (R) (D4), i-gel (R) (D5) and air-Q (R) (D6) were used to achieve a secure airway in the study. In the first week, 60 trainee paramedics made ten attempts with each device using a manikin that was immobilized with a collar. Eight weeks later, the trainees made ten more attempts with each device. Application times, success rates, and the device preferences of the trainees were compared. Results: When we analyzed total application times, the shortest times were identified in the D5 and D6 groups. The success rate was low in the D1 group in the first ten attempts. There was no statistically significant difference in the last ten attempts. When we evaluated application skills after eight weeks, application times were improved significantly in all groups. The trainees stated that they would prefer D2, D5, and D3 devices during CPR. Conclusions: Practitioners with sufficient experience had high success rates with both ETI and SAD even though application times were different during CPR. SADs without a cuff seem advantageous compared with the others regarding total application times. However, no success rate difference was observed with the other devices.