Effective rescue after failed intubation is important to limit the number of attempts and patient risk.[1]

A recent study from the Department of Anesthesiology at the University of Utah School of Medicine investigated the effectiveness of using video laryngoscopy (VL) in combination with the Total Control Introducer™ (TCI) as a rescue intubation technique. Below is a summary of the study.

THE TOTAL CONTROL INTRODUCER

The Total Control Introducer is an innovative articulating introducer without intrinsic optical capabilities. It has a flexible shaft and controllable tip enabling dynamic navigation and precision tracheal access when used with VL or DL. A modified combined technique using VL in combination with TCI takes advantage of VL’s visualization capability and the TCI’s dynamic and precise navigational capability. This allows difficult visualization of the glottis and/or difficult tracheal access to be solved simultaneously.[2],[3]

Total Control Introducer

THE STUDY

The study reviewed 34 cases in which the Total Control Introducer was used during a rescue attempt after failure to intubate with other airway techniques. Overall VL + TCI success was as follows:

  • 33 of 34 (97% success rate)
  • 32 of 33 (97%) were on the first pass and 1 of 33 was on the second pass.
  • 8 of 8 (100%) of cases when only direct laryngoscopy failed
  • 13 of 14 (93%) of cases when only video laryngoscopy failed
  • 12 of 12 (100%) when both direct laryngoscopy and video laryngoscopy failed
  • 1 of 1 (100%) where DL, VL and FOB failed.
Total Control Introducer Utah Study Chart

THE CONCLUSION

In this study, a modified combined technique, VL + TCI, was used to successfully intubate after failed attempts using DL, VL and even FOB. Most importantly, VL + TCI was able to rescue 100% of cases where both VL and DL failed. The success rate when using VL + TCI for rescue intubations found in this study is superior to published success rates of FOB, iSGA, lighted stylet, and optical stylets in rescue situations. The success of rate of VL + TCI found in this study is similar to published success rates of classic combined techniques utilizing VL + FOB.

Click here to read the complete study.

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References

[1] Shah, Ashka MD; Durnford, Katryn MS; Knecht, Lauren MD; Jacobson, Cameron MS; Runnels, Sean Torin MD A Consecutive Case Series of Rescue Intubations With the Articulating Total Control Introducer for Precision Tracheal Access, A & A Practice: March 2021 – Volume 15 – Issue 3 – p e01418 doi: 10.1213/XAA.0000000000001418

[2] Pollard J, Runnels S, Warrick C. First case report of intubation with a total control introducer and a hyperangulated video laryngoscope. A A Pract. 2020; 14:e01310.

[3] Keefe K, Cannon R, Runnels S. Successful intubation of a patient with a supraglottic tumor using a novel articulating introducer for precision tracheal access. J Head Neck Anesthesia. 2021; 5:e31.