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Comparative evaluation of Airtraq™ and GlideScope® videolaryngoscopes for difficult pediatric intubation in a Pierre Robin manikin

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Abstract

Airway management in children is associated with anatomical and physiological challenges compared with adults. Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis, and cleft palate and related to a difficult airway. Both the Airtraq™ and GlideScope® have never been previously directly compared in PRS. Our aim was to evaluate the performance of these two airway devices in a PRS manikin for ethical and practical reasons. Between April and July 2017, 26, pediatric intensive care clinical fellows or trainees from a tertiary pediatric center were recruited to participate. In this prospective and randomized crossover trial, all participants first set up the Airtraq™ and the GlideScope® and then used these videolaryngoscopes to intubate an AirSim® PRS manikin. Our primary outcome measure was the duration of the successful intubation attempt. Duration of the successful intubation attempt was 18.1 (14.2–34.9 [10.2–51.3]) s for the Airtraq™ compared to 31.1 (18.7–55.6 [6.2–119]) s for the GlideScope® (p = 0.045). Setup time was 50.0 ± 6.9 s for the Airtraq™ and 27.8 ± 8.6 s for the GlideScope® (p < 0.001).

Conclusion: Even though setup time was longer, the characteristics of intubation performance were superior with the Airtraq™ relative to the GlideScope® in an AirSim® PRS manikin.

What is Known:

• Several case reports have described the successful use of Airtraq™ to intubate children with Pierre Robin sequence.

• The GlideScope® has demonstrated similar rates of first-attempt successful intubation to flexible fiberoptic bronchoscopy in a Pierre Robin sequence manikin.

What is New:

• In the hands of pediatric non-airway specialists, the characteristics of intubation performance, including the duration of the successful intubation attempt, are superior with the Airtraq™ compared with the GlideScope® in a Pierre Robin sequence manikin.

• Setup time for the Airtraq™ is, however, longer relative to that for the GlideScope®.

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Abbreviations

DL:

Direct laryngoscopy

FFB:

Flexible fiberoptic bronchoscopy

IQR:

Interquartile range

NEAR4KIDS:

National Emergency Airway Registry for Children

NHS:

National Health Service

POGO:

Percentage of glottic opening

PRS:

Pierre Robin sequence

TTI:

Time to intubation

SD:

Standard deviation

VL:

Videolaryngoscope

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Acknowledgements

The authors would like to thank Dr. Emma Borrows, Consultant in Paediatric Critical Care at the Great Ormond Street Hospital for Children NHS Foundation Trust, for her assistance in the capture of photographs used in this manuscript. We wish to thank all the participants for their involvement in the study.

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Authors and Affiliations

  1. Department of Anaesthetics, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, UK

    Neel Desai

  2. Children’s Acute Transport Service, Ormond House, 26-27 Boswell Street, London, UK

    Mae Johnson, Kat Priddis, Samiran Ray & Linda Chigaru

  3. Department of Anaesthetics, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK

    Mae Johnson & Linda Chigaru

  4. Respiratory, Critical Care and Anaesthesia Section, University College London Great Ormond Street Institute of Child Health, 30 Guildford Street, London, UK

    Samiran Ray

Authors
  1. Neel Desai
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  2. Mae Johnson
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  3. Kat Priddis
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  4. Samiran Ray
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  5. Linda Chigaru
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Contributions

ND contributed to the design of the study, data collection, statistical analysis, and drafting and reviewing of the manuscript. MJ contributed to the data collection and drafting of the manuscript. KP contributed to the data collection. SR contributed to the statistical analysis. LC contributed to the design of the study, statistical analysis, and reviewing of the manuscript.

Corresponding author

Correspondence to Neel Desai.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

No formal ethical approval needed after consideration by the Joint Research and Development Office, and it was registered as a service evaluation.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Piet Leroy

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Desai, N., Johnson, M., Priddis, K. et al. Comparative evaluation of Airtraq™ and GlideScope® videolaryngoscopes for difficult pediatric intubation in a Pierre Robin manikin. Eur J Pediatr 178, 1105–1111 (2019). https://doi.org/10.1007/s00431-019-03396-7

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  • DOI: https://doi.org/10.1007/s00431-019-03396-7

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