• Christopher J Groombridge, Amit Maini, Cecil Johnny, David McCreary, Yesul Kim, SmitDe VilliersVNational Trauma Research Institute, Melbourne, Victoria, Australia.Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Au, and Mark Fitzgerald.
• National Trauma Research Institute, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2022 Jun 1; 34 (3): 411-416.

ObjectiveA supraglottic airway device (SAD) may be utilised for rescue re-oxygenation following a failed attempt at endotracheal intubation with direct or video laryngoscopy. However, the choice of subsequent method to secure a definitive airway is not clearly established. The aim of the present study was to compare two techniques for securing a definitive airway via the in-situ SAD.MethodsA randomised controlled trial was undertaken. The population studied was emergency physicians (EPs) attending a cadaveric airway course. The intervention was intubation through a SAD using a retrograde intubation technique (RIT). The comparison was intubation through a SAD guided by a flexible airway scope (FAS). The primary outcome was time to intubation. The trial was registered with ANZCTR.org.au (ACTRN12621000995875).ResultsFour EPs completed intubations using both methods on four cadavers for a total of 32 experiments. The mean time to intubation was 18.2 s (standard deviation 8.8) in the FAS group compared with 52.9 s (standard deviation 11.7) in the RIT group; a difference of 34.7 s (95% confidence interval 27.1-42.3, P < 0.001). All intubations were completed within 2 min and there were no equipment failures or evidence of airway trauma.ConclusionSuccessful tracheal intubation of cadavers by EPs is achievable, without iatrogenic airway trauma, via a SAD using either a FAS or RIT, but was 35 s quicker with the FAS.© 2021 Australasian College for Emergency Medicine.

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