Evaluation of the efficacy of six supraglottic devices for airway management in dark conditions: a crossover randomized simulation trial.

PURPOSE: During out-of-hospital cardiopulmonary resuscitation, several factors can render tracheal intubation more difficult, such as when rescuers must secure the airway in complete darkness or with limited illumination. The purpose of this study was to evaluate the efficacy of six supraglottic devices (SGDs), ProSeal(®) (ProSeal), Classic(®) (Classic), Supreme(®) (Supreme), Laryngeal Tube(®) (LT), air-Q(®) (air-Q), and i-gel(®) (i-gel), for airway management under light and dark conditions using a manikin.

METHODS: Seventeen novice doctors and 15 experienced doctors performed insertion of six SGDs under light and dark conditions using an adult manikin. Insertion time, successful ventilation rate, and subjective insertion difficulty on a visual analogue scale (VAS) were measured.

RESULTS: Both novice and experienced doctors had a significantly lower ventilation success rate in the dark than in the light when ProSeal and Classic were used, but not with the other four SGDs. Novice doctors required a significantly longer insertion time in the dark than in the light with all SGDs. Experienced doctors required a significantly longer insertion time in the dark than in the light with ProSeal or Classic, but not with the other four SGDs. VAS was significantly higher for both novice and experienced doctors when ProSeal and Classic were used, as compared with the other four SGDs in the dark.

CONCLUSIONS: Compared to ProSeal and Classic, Supreme, i-gel, LT, and air-Q are more effective for airway management in the dark. Our findings suggest that anatomically shaped SGDs may help novice doctors secure the airway under dark conditions.