The Easytube for airway management: a systematic review of clinical and simulation studies

Abstract

Study objective: Endotracheal intubation is considered the criterion-standard technique for securing the airway. Supraglottic airway devices (SADs) represent a major advance in airway management and are recommended by the guidelines in difficult situations such as Advanced Life Support and "cannot ventilate-cannot intubate" scenarios. The Easytube (EzT) is an SAD introduced a decade ago but not included yet in the above guidelines.

Design: Systematic review of MEDLINE and EMBASE according to PRISMA guidelines available up to January 12, 2016.

Setting: We collected experimental and clinical evidence regarding EzT positioning performed by medial students, anesthesiologists, paramedics, or nurses.

Patients: Manikins, cadavers, or patients.

Interventions: EzT positioning in both clinical and simulation studies, both under standard and under difficult scenarios.

Measurements: Time to insertion and time to ventilation, success rate and operator's assessment of the device, change in ventilatory parameters, and major complications.

Main results: Fifteen manuscripts were found: 6 prospective clinical studies and 9 conducted under experimental conditions (7 with a simulator and 2 on cadavers). The EzT inserted by both inexperienced and experienced personnel in most studies had high success rate, and it showed excellent results also during simulated cardiopulmonary resuscitation and in difficult airway scenarios. The EzT had better ventilatory parameters as compared with the Combitube and showed great airway sealing capacity, comparable to the Combitube and to the laryngeal mask airway and superior to other SADs. EzT allowed the insertion of large nasogastric tubes and has only mild adverse effects like other SADs. No major complications were described.

Conclusion: The EzT appears to be a safe and a good alternative to established SADs. It may be considered among SADs by future guidelines on Advanced Life Support and "cannot ventilate-cannot intubate" scenarios.

Keywords: Anesthesia; Combitube; Endotracheal Intubation; EzT; Laryngeal Mask.