Table 2.
Effectiveness of a selection of alternatives to direct laryngoscopy in the difficult airway
| Population | Published benefit | Level(s) of evidence & references |
|---|---|---|
| LMA Fastrach™ (LMA North America Inc., San Diego, CA) | ||
| Patients with failed Macintosh direct laryngoscopy (DL) | Successful ventilation/intubation | C: (43,70,80-85) |
| Patients with predicted difficult intubation by DL | Successful ventilation/intubation | |
| Obese patients | Successful ventilation/intubation |
B: (95) C: (96) |
| Patients with manual in-line stabilization | Successful ventilation/intubation |
B: (97) |
| air-Q™ (Cookgas LLC, St. Louis, MO) | ||
| Patients with difficult laryngoscopy | Successful intubation (endoscopic-aided) | C: (92,99,100) |
| Bronchoscopic-aided intubation through a supraglottic device | ||
| Patients with failed Macintosh DL | Successful ventilation/intubation | C: (43) |
| Patients with predicted difficult intubation by DL | Successful ventilation/intubation | B: (86) C: (101) |
| Bronchoscopic- and Aintree catheter-aided intubation through a supraglottic device | ||
| Patients with predicted difficult intubation by DL | Successful intubation | B: (102) C: (103-105) |
| Intubating lighted stylets | ||
| Patients with failed Macintosh DL | Successful intubation | C: (106) |
| Patients with predicted difficult intubation by DL | Successful intubation | A: (107) B: (108) |
| Patients with MILS | Successful intubation | B: (109) |
| GlideScope® videolaryngoscope (Verathon Medical Canada ULC, Burnaby, BC) | ||
| Patients with failed Macintosh DL | Successful intubation | B: (78,110) C: (111-113) |
| Patients with predicted difficult intubation by DL | Improved view | A: (114,115) C: (116) |
| Successful intubation | A: (117) B: (78,118,119) C: (115) | |
| Patients with MILS | Improved view | A: (120) B: (121) C: (122-124) |
| Successful intubation | B: (125) C: (121) | |
| Patients with ankylosing spondylitis | Successful intubation | C: (126,127) |
| Obese patients | Improved view | A: (128-130) B: (131) |
| Successful intubation | A: (129) B: (95,130) C: (132) | |
| Awake intubation | C: (133) | |
| Patients with upper airway tumours | Improved view | A: (134) |
| McGrath® Series 5 video laryngoscope (LMA North America Inc., San Diego, CA) | ||
| Patients with failed Macintosh DL | Successful intubation | C: (135,136) |
| Patients with predicted difficult intubation by DL | Improved view | C: (137) |
| Successful intubation | B: (138) | |
| Awake intubation | B: (139) | |
| Patients with MILS | Successful intubation | B: (140) |
| Obese patients | Improved view | A: (128) |
| Storz C-MAC® (with Macintosh blade) (Karl Storz Endoscopy, El Segundo, CA) | ||
| Patients with failed Macintosh DL | Improved view | B: (141) |
| Successful intubation | B: (141) | |
| Patients with predicted difficult intubation by DL | Successful intubation | A: (142) B: (138) |
| Obese patients | Improved view | A: (128) |
| Storz C-MAC® (with D-blade) (Karl Storz Endoscopy, El Segundo, CA) | ||
| Patients with failed Macintosh DL | Improved view | B: (143) |
| Successful intubation | B: (143) | |
| Patients with predicted difficult intubation by DL | Improved view | B: (144) |
| Successful intubation | B: (144) | |
| Ambu® Pentax Airway Scope (Ambu Inc., Glen Burnie, MD) | ||
| Patients with failed Macintosh DL | Successful intubation | B: (145-147) C: (148) |
| Patients with predicted difficult intubation by DL | Successful intubation | A: (117) |
| Patients with MILS | Improved view | A: (120) B: (123) C: (149) |
| Successful intubation | A: (120,150) B: (123) C: (149) | |
| Airtraq (Southmedic Inc., Barrie, ON) | ||
| Patients with failed Macintosh DL | Successful intubation | C: (151) |
| Patients with predicted difficult intubation by DL | Faster intubation; reduction in intubation difficulty score | B: (152) C: (153) |
| Successful intubation | C: (153) | |
| Patients with upper airway tumours | Improved view | A: (134) |
| Flexible bronchoscopic intubation | ||
| Anesthetized patients with failed Macintosh DL | Successful intubation | B: (154,155) C: (83) |
| Successful intubation (with use of a laryngeal mask airway and Aintree catheter) | B: (102) | |
| Patients with predicted difficult intubation by DL | Successful intubation | A: (86) B: (87) C: (139,156) |
| Successful awake intubation | B: (139) | |
| Anesthetized patients with MILS | Successful intubation | B: (157) |
| Clarus Video System (Clarus Medical, St. Paul, MN) | ||
| Patients with predicted difficult intubation by DL | Successful intubation | B: (158) |
| Patients with C-spine immobilization or injury | Successful intubation | A: (159) |
| Storz Bonfils intubation endoscope (Karl Storz Endoscopy, El Segundo, CA) | ||
| Patients with failed Macintosh DL | Successful intubation | C: (160-162) |
| Patients with predicted difficult intubation by DL | Successful intubation; awake intubation | B: (88) C: (163-165) |
| Clarus Shikani optical stylet (Clarus Medical, St. Paul, MN) | ||
| Patients with MILS | Successful intubation | B: (121) C: (166) |
| Clarus Levitan optical stylet (Clarus Medical, St. Paul, MN) | ||
| Patients with simulated difficult DL | Successful intubation | B: (74) |
DL = direct laryngoscopy; MILS = manual in-line stabilization