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

BackgroundCervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.MethodsMEDLINE, EMBASE, and Cochrane Library were searched to identify randomised trials comparing two or more adults with cervical immobilisation. After critical appraisal, a random-effects network meta-analysis was used pool compare device performance. The primary outcome probability first-attempt success (first-pass success). For performance, Macintosh direct laryngoscopy blade chosen as reference device.ResultsWe included 80 (8039 subjects) 26 devices. Compared Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19–46.20), C-MAC D Blade™ (OR=7.44; CrI, 1.06–52.50), Airtraq™ (OR=5.43; 2.15–14.2), King Vision™ (OR=4.54; 1.28–16.30), C-MAC™ (OR=4.20; CrI=1.28–15.10) had greater first-pass success. This also true for GlideScope™ when tube guide (OR=3.54; 1.05–12.50). Only Airway Scope™ better compared manual-in-line stabilisation (MILS) technique (OR=7.98; 1.06–73.00).ConclusionsFor performed immobilisation, seven Macintosh. However, studies using MILS (rather than collar other alternative) are needed, which accurately represent clinical practice.Clinical trial registrationPROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067).