The effectiveness of paediatric blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask – a randomised, cross-over, simulation trial

Introduction
The main causes of cardiac arrest in paediatric patients are airway obstruction and progressive hypoxia. Rapid endotracheal intubation and the implementation of mechanical ventilation during cardiopulmonary resuscitation (CPR) can affect the minimisation of chest compressions and adequate oxygenation of the blood, and thus increase the chances of spontaneous circulation return.

Aim of the study
The aim of the study was to compare intubation using a standard Macintosh blade (MAC) laryngoscope and blind intubation using an AmbuR AuraGain™ Disposable Laryngeal Mask (AMBU) as a guide for the tracheal tube under simulated CPR conditions of a paediatric patient with and without chest compressions.

Material and methods
Fifty-six students from the final year of medicine studies participated in this trial. The study was designed as a randomised, cross-over, simulation study. Participants of the study performed endotracheal intubation during simulated CPR of a paediatric patient, with and without chest compressions during an intubation procedure. Participants had a maximum of three attempts to intubate each of the techniques in individual research scenarios.

Results
The median time of intubation in CPR without chest compressions using MAC and AMBU was 32 s (interquartile range – IQR; 27–41.5) and 30 s (IQR; 22–43), respectively. The efficacy of the first intubation trial was 28.6% for MAC and 48.2% for AMBU, and the total intubation efficiency for both techniques was 100%. In the case of intubation during uninterrupted chest compressions, blind intubation using AMBU as the guide for the endotracheal tube was associated with better parameters than in the case of intubation using MAC, with respect to both intubation time (32 s [IQR; 22–45] and 47 s [IQR; 33–57], respectively; p = 0.017), effectiveness of the first intubation trial (33.9% and 5.4%, p = 0.002), as well as the total effectiveness of intubation (73.2% and 46.2%, p < 0.001).

Conclusions
In our study, blind endotracheal intubation using AMBU was associated with more effective endotracheal intubation than standard intubation using direct laryngoscopy, both when the chest compressions were interrupted for the time of intubation and in the case of intubation during uninterrupted chest compressions.