To the Editor:

In the recent report by Arslan et al. [1] comparing face-to-face intubation using Airtraq, Glidescope and Fastrach devices in adult patients, we believe there are design limitations that make interpretation of their findings questionable. The aim of their study was to evaluate the performance of three devices for emergency intubation in a prehospital environment; however, it was conducted in a controlled environment, i.e., intubation was performed in anesthetized, paralyzed patients lying on an operating table under room light. In an actual prehospital situation, emergency intubation is often required to be conducted in patients lying on the ground in direct daylight. A common flaw of videolaryngoscopes, including Airtraq and Glidescope, is that reflection of the sunlight on the video monitors may make it difficult to see the glottis in daylight [2]. Moreover, the height of the operating table can affect the performance of laryngoscopic intubation. In addition, comparing intubation times with three devices is not entirely appropriate. The ventilatory capacity of the Fastrach device is arguably equally important to its effectiveness as an intubation conduit during airway resuscitation. If intubation via the Fastrach device fails, the presence of an effective airway can evidently be lifesaving.

Finally, in Table 2, the total number of patients requiring different attempts in the Glidescope and Fastrach groups is more than the actual sample sizes.