Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis

Date

2021-05-01

Author

Singleton, Barry N.
Morris, Fiachra K.
Yet, Barbaros
Buggy, Donal J.
Perkins, Zane B.

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Background: Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain. Methods: 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. Results: We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]¼11.5; 95% credible interval [CrI] 3.19e46.20), C-MAC D Blade™ (OR¼7.44; 95% CrI, 1.06e52.50), Airtraq™ (OR¼5.43; 95% CrI, 2.15e14.2), King Vision™ (OR¼4.54; 95% CrI, 1.28e16.30), and C-MAC™ (OR¼4.20; 95% CrI¼1.28e15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR¼3.54; 95% CrI, 1.05e12.50). 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 (OR¼7.98; 95% CrI, 1.06e73.00). Conclusions: 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 alter- native) are needed, which more accurately represent clinical practice. Clinical trial registration: PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php? RecordID¼158067).

Subject Keywords

Airway, Cervical immobilisation, Cervical spine, Difficult airway, Intubation

URI

https://hdl.handle.net/11511/90702

Journal

BRITISH JOURNAL OF ANAESTHESIA

DOI

https://doi.org/10.1016/j.bja.2020.12.041

Collections

Graduate School of Informatics, Article

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Citation Formats

B. N. Singleton, F. K. Morris, B. Yet, D. J. Buggy, and Z. B. Perkins, “Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis,” BRITISH JOURNAL OF ANAESTHESIA, pp. 1055–1066, 2021, Accessed: 00, 2021. [Online]. Available: https://hdl.handle.net/11511/90702.