Glidescope+aScope = Win for Difficult Airway

Written by Clay Smith

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In patients with predicted difficult airway, use of a Glidescope plus fiberoptic scope (aScope, Ambu) as a dynamic, controllable stylet vs Glidescope with usual stylet resulted in much higher first-pass success, 91% vs 67%, NNT = 4.

Why does this matter?
While we may be able to see the glottic opening better with a hyperangulated video scope, that doesn't mean we can make the tube pass, even with the non-flexible, preformed Glidescope stylet.  Would the Glidescope and a flexible fiberscope work better?  The scope used in this study was the single-use disposable aScope by Ambu.  See the aScope in action in this YouTube video.

Glidescope + aScope for the win
This was a RCT of 160 patients in the OR with predicted difficult airway who were intubated with either a Glidescope (G-only) (stylet was not the manufacturer-issued version but was a disposable one, formed and angled by the anesthesiologist) or Glidescope + aScope (G+scope).  The fiberoptic scope used was not plugged into the monitor but was merely used as a flexible “stylet” viewed indirectly on the Glidescope monitor.  Bear in mind, these were all experienced anesthesiologists, in a controlled OR setting.  First-pass success was 91% with the G+scope group compared to 67% in the G-only group (p=0.001); RR 3.7; NNT = 4.  The leading rescue maneuver in the G-only group was to use a fiberscope (77% of failed attempts).  Median intubation time was 50 seconds in the G+scope group vs 64 seconds in the G-only group (p=0.035).  Airway injury occurred in 11% of the G-only group vs only 1% of the G+scope patients (p=0.035). 

Source
Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial.  Anesth Analg. 2019 Mar 7. doi: 10.1213/ANE.0000000000004102. [Epub ahead of print]

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Reviewed by Thomas Davis

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