Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis
Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain. MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more in...
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| Published in | British journal of anaesthesia : BJA Vol. 126; no. 5; pp. 1055 - 1066 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.05.2021
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| Subjects | |
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| Abstract | Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.
MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device.
We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19–46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06–52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15–14.2), King Vision™ (OR=4.54; 95% CrI, 1.28–16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28–15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05–12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06–73.00).
For intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice.
PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067). |
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| AbstractList | Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.BACKGROUNDCervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device.METHODSMEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device.We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19-46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06-52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15-14.2), King Vision™ (OR=4.54; 95% CrI, 1.28-16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28-15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05-12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06-73.00).RESULTSWe included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19-46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06-52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15-14.2), King Vision™ (OR=4.54; 95% CrI, 1.28-16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28-15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05-12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06-73.00).For intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice.CONCLUSIONSFor intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice.PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067).CLINICAL TRIAL REGISTRATIONPROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067). Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain. MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device. We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19–46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06–52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15–14.2), King Vision™ (OR=4.54; 95% CrI, 1.28–16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28–15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05–12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06–73.00). For intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice. PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067). |
| Author | Morris, Fiachra K. Perkins, Zane B. Buggy, Donal J. Yet, Barbaros Singleton, Barry N. |
| Author_xml | – sequence: 1 givenname: Barry N. surname: Singleton fullname: Singleton, Barry N. email: barry.singleton@gmail.com organization: Department of Anaesthesiology and Critical Care Medicine, Our Lady's Children's Hospital Crumlin, Dublin, Ireland – sequence: 2 givenname: Fiachra K. surname: Morris fullname: Morris, Fiachra K. organization: Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland – sequence: 3 givenname: Barbaros surname: Yet fullname: Yet, Barbaros organization: Graduate School of Informatics, Middle East Technical University, Ankara, Turkey – sequence: 4 givenname: Donal J. surname: Buggy fullname: Buggy, Donal J. organization: Department of Anaesthesiology and Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland – sequence: 5 givenname: Zane B. surname: Perkins fullname: Perkins, Zane B. organization: Centre for Trauma Sciences, Queen Mary University of London, London, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33610262$$D View this record in MEDLINE/PubMed |
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| Keywords | trauma cervical spine airway intubation difficult airway spinal injury cervical immobilisation |
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| SubjectTerms | Adult airway cervical immobilisation cervical spine Cervical Vertebrae difficult airway Equipment Design Humans Immobilization intubation Intubation, Intratracheal - instrumentation Intubation, Intratracheal - methods Laryngoscopes Laryngoscopy - instrumentation Laryngoscopy - methods Randomized Controlled Trials as Topic spinal injury trauma |
| Title | Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis |
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