Evaluation of five static or dynamic tracheal tube introducers during standard and difficult intubations with C‐ <scp>MAC</scp> <sup>®</sup> D‐blade videolaryngoscopy in a manikin*
Benjamin Dallyn, Ronan Hanratty, Mathew Hillier, M. J. G. Ainsworth, Jan Hansel, Tim Cook
Abstract
INTRODUCTION: Tracheal tube introducers facilitate tracheal intubation and include stylets and static/dynamic bougies. There is uncertainty over the most efficacious introducer with hyperangulated videolaryngoscopy. METHODS: We evaluated five introducers. Thirty anaesthetists intubated a manikin 10 times with a reusable C-MAC® D-blade videolaryngoscope using five introducers in two airway setups. Airway setup was allocated randomly to standard or difficult tracheal intubation and the order of use of five introducers: two stylets (C-MAC Stylet; Universal Stylet Bougie™); two dynamic bougies (Total Control Introducer™; Steerable Tracheal Intubation Guide™); and a static bougie (Portex® Bougie). The primary outcome was first-attempt tracheal intubation success. Secondary outcomes were tracheal intubation within 120 seconds; time to tracheal intubation; and operator-rated ease of tracheal intubation, railroading and force required. RESULTS: With the standard tracheal intubation setup, first-attempt tracheal intubation success rates (95%CI) were: C-MAC Stylet 100% (100-100%); Universal Stylet Bougie 93% (84-100%); Total Control Introducer 90% (79-100%); Steerable Tracheal Intubation Guide 80% (65-95%); and Portex bougie 57% (37-76%). With the difficult tracheal intubation setup, first-attempt tracheal intubation success rates (95%CI) were: C-MAC Stylet 93% (84-100%); Total Control Introducer 87% (74-99%); Universal Stylet Bougie 73% (56-90%); Steerable Tracheal Intubation Guide 60% (41-79%); and Portex bougie 33% (15-51%). The C-MAC Stylet was best and the static bougie worst across all outcomes, with differences greater when tracheal intubation was designed to be difficult. In pairwise comparisons of tracheal intubation first-attempt success in the difficult airway, the C-MAC Stylet, Universal Stylet Bougie and Total Control Introducer were statistically significantly better than the Portex Bougie; the C-MAC stylet was also statistically significantly better than the Steerable Tracheal Intubation Guide. DISCUSSION: Among introducers for hyperangulated videolaryngoscopy, stylets were most efficacious and a static bougie least. Differences in performance increased when tracheal intubation was difficult.