Does the revised intubating laryngeal tube (ILTS-D2) perform better than the intubating laryngeal mask (Fastrach)? - a randomised simulation research study

Thomas Ott, Katharina Tschöpe, Gerrit Toenges, Holger Buggenhagen, Kristin Engelhard, Marc Kriege, Thomas Ott, Katharina Tschöpe, Gerrit Toenges, Holger Buggenhagen, Kristin Engelhard, Marc Kriege

Abstract

Background: The intubating laryngeal tube (ILTS-D™) and the intubating laryngeal mask (Fastrach™) are devices that facilitate both extraglottic application and blind tracheal intubation. A revised model of the iLTS-D (for scientific reasons called ILTS-D2) has been designed but not yet evaluated. Therefore, we compared the ILTS-D2 with the established Fastrach under controlled conditions in a prospective randomised controlled simulation research study.

Methods: After ethical approval, we randomised 126 medical students into two groups. Each participant received either Fastrach or ILTS-D2 to perform five consecutive ventilation attempts in a manikin. The primary endpoint was the time to ventilation in the last attempt of using the devices as extraglottic devices. Secondary endpoints were the time to tracheal intubation and the success rates.

Results: There was no relevant difference between the two devices in the time to ventilation in the last of five attempts (Fastrach: median 14 s [IQR: 12-15]; ILTS-D2: median 13 s [IQR: 12-15], p = 0.592). Secondary endpoints showed a 2 s faster blind tracheal intubation using the Fastrach than using the ILTS-D2 (Fastrach: median 14 s [IQR: 13-17]; ILTS-D2: median 16 s [IQR: 15-20] p < 0.001). For both devices, the success rates were 100% in the last attempt.

Conclusions: Concerning extraglottic airway management, we could not detect a relevant difference between the revised ILTS-D2 and the Fastrach under laboratory conditions. We advocate for an evaluation of the ILTS-D2 in randomised controlled clinical trials.

Trial registration: Identifier at clinicaltrials.gov: NCT03542747. May 31, 2018.

Keywords: Airway management [E02.041]; Intubation [E05.497.578]; Laryngeal masks [E05.497.578.475]; Manikins [J01.897.280.500.545.129.400]; [MeSH tree numbers]: simulation.

Conflict of interest statement

The authors declare that there is no conflict of interests.

Figures

Fig. 1
Fig. 1
ILTS-D2 (left) and its precursor iLTS-D® (right) in direct comparison. Details are described in the main text
Fig. 2
Fig. 2
CONSORT flow chart

References

    1. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–848. doi: 10.1093/bja/aev371.
    1. Benoit JL, Gerecht RB, Steuerwald MT, McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: a meta-analysis. Resuscitation. 2015;93:20–26. doi: 10.1016/j.resuscitation.2015.05.007.
    1. Timmermann A, Russo SG, Crozier TA, Eich C, Mundt B, Albrecht B, et al. Novices ventilate and intubate quicker and safer via intubating laryngeal mask than by conventional bag-mask ventilation and laryngoscopy. Anesthesiology. 2007;107(4):570–576. doi: 10.1097/01.anes.0000281940.92807.23.
    1. Ott T, Fischer M, Limbach T, Schmidtmann I, Piepho T, Noppens RR. The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) - a prospective randomised manikin study. Scand J Trauma Resusc Emerg Med. 2015;23(1):44. doi: 10.1186/s13049-015-0126-y.
    1. Bergold MN, Kahle S, Schultzik T, Bucheler M, Byhahn C. Intubating laryngeal tube suction disposable: initial clinical experiences with a novel device for endotracheal intubation. Anaesthesist. 2016;65(1):30–35. doi: 10.1007/s00101-015-0100-0.
    1. Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, et al. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Adv Simul (Lond) 2016;1:25. doi: 10.1186/s41077-016-0025-y.
    1. Kriege M, Alflen C, Eisel J, Ott T, Piepho T, Noppens RR. Evaluation of the optimal cuff volume and cuff pressure of the revised laryngeal tube "LTS-D" in surgical patients. BMC Anesthesiol. 2017;17(1):19. doi: 10.1186/s12871-017-0308-4.
    1. Ydemann M, Rovsing L, Lindekaer AL, Olsen KS. Intubation of the morbidly obese patient: GlideScope((R)) vs Fastrach. Acta Anaesthesiol Scand. 2012;56(6):755–761. doi: 10.1111/j.1399-6576.2012.02693.x.
    1. Schalk R, Eichler K, Bergold MN, Weber CF, Zacharowski K, Meininger D, et al. A radiographic comparison of human airway anatomy and airway manikins--implications for manikin-based testing of artificial airways. Resuscitation. 2015;92:129–136. doi: 10.1016/j.resuscitation.2015.05.001.
    1. Munster T, Stosch C, Hindrichs N, Franklin J, Matthes J. Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression - a pilot study. GMS J Med Educ. 2016;33(4):Doc60.
    1. Perkins GD, Handley AJ, Koster RW, Castren M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81–99. doi: 10.1016/j.resuscitation.2015.07.015.
    1. Preece G, Ng I, Lee K, Mezzavia P, Krieser R, Williams DL, et al. A randomised controlled trial comparing fibreoptic-guided tracheal intubation through two supraglottic devices: Ambu(R) AuraGain laryngeal mask and LMA(R) Fastrach. Anaesth Intensive Care. 2018;46(5):474–479. doi: 10.1177/0310057X1804600508.
    1. Schalte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, et al. Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin. Scand J Trauma Resus. 2011;19:60–68. doi: 10.1186/1757-7241-19-60.
    1. Castle N, Pillay Y, Spencer N. Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: a manikin study. Anaesthesia. 2011;66(11):983–988. doi: 10.1111/j.1365-2044.2011.06816.x.
    1. Ott T, Barth A, Kriege M, Jahn-Eimermacher A, Piepho T, Noppens RR. The novel video-assisted intubating laryngeal mask Totaltrack compared to the intubating laryngeal mask Fastrach - a controlled randomized manikin study. Acta Anaesthesiol Scand. 2017;61(4):381–389. doi: 10.1111/aas.12872.
    1. Sherren PB, Kong ML, Chang S. Comparison of the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway in a difficult airway with manual in-line stabilisation a cross-over simulation-based study. Eur J Anaesthesiol. 2013;30(9):544–549. doi: 10.1097/EJA.0b013e3283615b80.
    1. Wiesmann T, Doffert J, Steinfeldt T. Peripheral regional anesthesia without any complications - a dream comes true?! Anasthesiol Intensivmed Notfallmed Schmerzther. 2018;53(4):252–268. doi: 10.1055/s-0043-104664.
    1. Piepho T, Cavus E, Noppens R, Byhahn C, Dorges V, Zwissler B, et al. S1 guidelines on airway management. Anaesthesist. 2015;64(11):859–873. doi: 10.1007/s00101-015-0087-6.
    1. Sorbello M, Petrini F. Supraglottic airway devices: the search for the best insertion technique or the time to change our point of view? Turk J Anaesthesiol Reanim. 2017;45(2):76–82. doi: 10.5152/TJAR.2017.67764.
    1. Cumin D, Weller JM, Henderson K, Merry AF. Standards for simulation in anaesthesia: creating confidence in the tools. Brit J Anaesth. 2010;105(1):45–51. doi: 10.1093/bja/aeq095.
    1. Cook TM, Kelly FE. Time to abandon the 'vintage' laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth. 2015;115(4):497–499. doi: 10.1093/bja/aev156.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe