Supraglottic airway devices for blind endotracheal intubation: A systematic review

by Jorman H. Tejada-Perdomo, Carlos E. Melo-Moreno, Jesús H. Tovar-Cardozo, Jorge A. Ramos-Castaneda

The effectiveness of supraglottic airway devices (SGDs) as a strategy for blind endotracheal intubation (ETI) was compared in this study.

A systematic review of clinical trials (CTs) involving SGDs for blind ETI in patients under general anesthesia or simulation manikins, was conducted. CTs that used SGDs for fiberoptic-guided ETI and those conducted in children were excluded. Searches were performed in Embase, MEDLINE (PubMed), Scopus, and LILACS. The primary outcomes examined were the success rate of blind ETI and intubation time. Secondary outcomes were first-attempt intubation success rate and perceived ease of use.

A total of 567 records were identified from databases, and 16 were identified through citation searches. Ultimately, 27 CTs met the inclusion criteria. The Fastrach Intubating Laryngeal Mask Airway (LMA Fastrach), i-gel, Air-Q Intubating Laryngeal Airway, and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T.) were the most used SGDs for blind ETI. LMA Fastrach was the most frequently compared device in these CTs. Among the studies in patients, LMA Fastrach and i-gel were the devices that showed the shortest intubation time, although it may be influenced by the way intubation time is assessed. The SGDs with the highest overall success rate were i-gel, S.A.L.T., LMA Fastrach, and single-use LMA Fastrach, followed by Air-Q, and the Intubating Laryngeal Tube Suction-Disposable (iLTS-D2), all achieving success rates greater than 90%. AuraGain had the lowest first-attempt and overall success rates for blind ETI with SGDs.

New SGDs have not surpassed the LMA Fastrach effectiveness for blind ETI. The single-use LMA Fastrach combines the efficacy of the reusable LMA Fastrach with the features of other SGDs and may be a suitable replacement for them. The I-gel is also a viable alternative for blind ETI, while the AuraGain may not be recommended for this purpose.