TraumaNCT00664612
Comparison of AirTraq Laryngoscope to Macintosh Laryngoscope for Intubation of Patients With Potential Cervical Spine Injury
A study testing AirTraq in people with Trauma, run by London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's at 1 site in Canada.
Trial summary
Intubation is frequently required for trauma patients as part of the resuscitative effort. When the stability of the cervical spine is unknown, the potential for spinal cord damage during intubation is significant; the question of the safest intubating technique has not been resolved. Read more about this study
- Who is it for?
- Ages 18 to 75 yearsHealthy volunteers can take part
- Conditions the study is for
- Trauma
- What is being tested?
- AirTraq
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 24 participants
- Where
- 1 siteCanada
- Study dates
- Jan 2008to May 2008
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Elective non-cardiac surgery patients requiring intubation for the surgery.
- (Cardiac surgery uses TEE; there would not be space for the fluoroscopy machine.)
- ASA 1-3
- Body Mass Index (BMI) < 35
Who cannot join
- patients with previous neck surgery or unstable C-spine
- patients with Reflux disease (GERD)
- patients who are or may be pregnant
Trial locations and contacts
1 site in 1 country.
About this study
Intubation is frequently required for trauma patients as part of the resuscitative effort. When the stability of the cervical spine is unknown, the potential for spinal cord damage during intubation is significant; the question of the safest intubating technique has not been resolved. Previous Studies have evaluated Macintosh Laryngoscopy, Bullard Laryngoscope, face mask ventilation, fibre-optic guided oral and nasal intubation, esophageal Combitube®, Laryngeal Mask Airway® (LMA), and Intubating Laryngeal Mask Airway® (ILMA) use with respect to cervical spine movement. Our previous study evaluated the Intubating Lighted Stylet (Lightwand®) and GlideScope® versus the Macintosh Laryngoscope.
Another method of securing endotracheal intubation, approved and in routine use, is the AirTraq® videolaryngoscope (ProMedic, Inc, Bonita Springs, FL, USA). The AirTraq videolaryngoscope is a videolaryngoscope with an external video display of the glottic opening and an endotracheal tube track to guide the ETT through the vocal cords (www.airtraq.com). When a clear view of the vocal cords is obtained, the endotracheal tube may be advanced into the trachea. This technique can be performed rapidly and safely and there is the perception that it involves less cervical spine movement than direct laryngoscopy.
We propose to study the AirTraq videolaryngoscope to determine if its use would result in reduced cervical spine movement during intubation.
Read the detailed description
With the surgeon's consent, informed and written consent will be ob¬tained from patients who are undergoing elective surgery requiring general anesthesia with endotracheal intubation. Preoperative clinical assessment of the patients will include routine airway evaluation of dentition, mouth opening, tongue size, Mallampati score, and neck mobility, as well as height, weight, and age.
While awake, the patients will be placed on the operating room table with a rigid board under their head, neck, and torso in order to simulate the table on which patients involved in trauma are placed in the emergency room. In-line stabilization (ILS), as recommended by the ATLS guidelines, will be applied to maintain the patient's head in the neutral position and reduce neck movement dur¬ing laryngoscopy.
After standard pre-oxygenation, anesthesia will be induced in routine fashion with 2 3 mg/kg propofol and 2-5 mcg/kg fentanyl; rocuro¬nium 0.8 mg/kg will be administered to effect muscle paralysis. The patient will be then be ventilated with 100% O2 via bag/mask for 3 minutes. (Oxygenation with 100% O2 provides an oxygen reservoir for at least 5 minutes while laryngoscopy is completed.) This is the standard of care in anesthesia.
After the patient is anesthetized, a sealed envelope containing computer a generated random assignment will be opened. Laryngoscopy will then be performed two times, with the Macintosh laryngoscope and with the AirTraq videolaryngoscope, in random order as determined by the envelope. Between laryngoscopies, the patient will be ventilated with sevoflurane in 100% oxygen.
Male patients will be intubated with an 8.0 mm inner diameter endotracheal tube (ETT) and women with a 7.0 mm or 7.5 mm ETT at the discretion of the anesthesiologist.
For AirTraq videolaryngoscopy, the AirTraq will be inserted and a view of the vocal cords will be obtained. The ETT will be advanced through the track until the tip of the ETT is visible at the glottic opening and then removed with the AirTraq videolaryngoscope.
For direct Macintosh laryngoscopy, a size 3 laryngoscope blade will be recommended in all patients, but the anesthesiologist may choose another size if deemed necessary. With laryngoscopy, the glottis will be exposed to enable positioning of the endotracheal tube at the vocal cords.
During the second laryngoscopy in the above sequence, the trachea will be intubated. The study is then complete. The hard board will be removed and the surgery will proceed in the usual fashion.
The laryngoscopy and intubation will be recorded by a portable fluoroscopy unit for subsequent review by the radiologist to assess cervical spine movement.
Laryngoscopy time will be defined as the time from when the laryngoscope blade or AirTraq videolaryngoscope passes the teeth of the patient until the time the endotracheal tube is positioned at the opening of the larynx. If the intubation sequence is longer than 120 seconds, it will be deemed a failure and recorded as such.
The Cormack-Lehane score, representing the degree of glottic exposure, of the larynx will be recorded for all patients. Blood oxygen saturation, heart rate, and blood pressure will be recorded every minute during the study.
To minimize inter-operator variability, all bag-mask ventilation, laryngoscopy, and intubation will be completed by one person.
- Conditions
- Trauma
- Being tested
- AirTraq
- Keywords
- Cervical Spine
- Medical subject headings
- Wounds and Injuries
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
AirTraqDevice
Laryngoscopy with AirTraq
| Study group | Role | What they receive |
|---|---|---|
| 1 | Experimental | Air Traq then Macintosh Receives: Device: AirTraq |
| 2 | Experimental | Macintosh then AirTraq Receives: Device: AirTraq |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cervical Spine Movement
Measured: Intubation
Secondary outcomes (1)
Time to Intubation
Measured: Intubation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Apr 2008 (estimated)
- Study startJan 2008
- Primary completionMay 2008
- Study completionMay 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for TraumaStudies of the same condition, open and under way.
- More trials run by London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- None (open label)
- Enrolment
- 24 participants (actual)
Sponsor and investigators
- Lead sponsor
- London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
- Sponsor type
- University, hospital or other
- Investigators
- Timothy P Turkstra, MD, Principal investigator, Western University, Canada
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00664612
- Sponsor's protocol ID
- R-07-337
- Other IDs
- 13481
- Status last verified
- Oct 2008
- First submitted
- 18 Apr 2008
- Last updated
- 16 Oct 2008
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 16 Oct 2008. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of AirTraq Laryngoscope to Macintosh Laryngoscope for Intubation of Patients With Potential Cervical Spine Injury
- ClinicalTrials.gov ID
- NCT00664612
- Acronym / sponsor ID
- R-07-337
- Conditions
- Trauma
- Keywords
- Cervical Spine
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 24 participants (actual)
- Lead sponsor
- London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sUniversity, hospital or other
- Study start
- Jan 2008
- Primary completion
- May 2008 (actual)
- Study completion
- May 2008 (actual)
- First posted
- 23 Apr 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Intubation is frequently required for trauma patients as part of the resuscitative effort. When the stability of the cervical spine is unknown, the potential for spinal cord damage during intubation is significant; the question of the safest intubating technique has not been resolved. Previous Studies have evaluated Macintosh Laryngoscopy, Bullard Laryngoscope, face mask ventilation, fibre-optic guided oral and nasal intubation, esophageal Combitube®, Laryngeal Mask Airway® (LMA), and Intubating Laryngeal Mask Airway® (ILMA) use with respect to cervical spine movement. Our previous study evaluated the Intubating Lighted Stylet (Lightwand®) and GlideScope® versus the Macintosh Laryngoscope.
Another method of securing endotracheal intubation, approved and in routine use, is the AirTraq® videolaryngoscope (ProMedic, Inc, Bonita Springs, FL, USA). The AirTraq videolaryngoscope is a videolaryngoscope with an external video display of the glottic opening and an endotracheal tube track to guide the ETT through the vocal cords (www.airtraq.com). When a clear view of the vocal cords is obtained, the endotracheal tube may be advanced into the trachea. This technique can be performed rapidly and safely and there is the perception that it involves less cervical spine movement than direct laryngoscopy.
We propose to study the AirTraq videolaryngoscope to determine if its use would result in reduced cervical spine movement during intubation.
Detailed description
With the surgeon's consent, informed and written consent will be ob¬tained from patients who are undergoing elective surgery requiring general anesthesia with endotracheal intubation. Preoperative clinical assessment of the patients will include routine airway evaluation of dentition, mouth opening, tongue size, Mallampati score, and neck mobility, as well as height, weight, and age.
While awake, the patients will be placed on the operating room table with a rigid board under their head, neck, and torso in order to simulate the table on which patients involved in trauma are placed in the emergency room. In-line stabilization (ILS), as recommended by the ATLS guidelines, will be applied to maintain the patient's head in the neutral position and reduce neck movement dur¬ing laryngoscopy.
After standard pre-oxygenation, anesthesia will be induced in routine fashion with 2 3 mg/kg propofol and 2-5 mcg/kg fentanyl; rocuro¬nium 0.8 mg/kg will be administered to effect muscle paralysis. The patient will be then be ventilated with 100% O2 via bag/mask for 3 minutes. (Oxygenation with 100% O2 provides an oxygen reservoir for at least 5 minutes while laryngoscopy is completed.) This is the standard of care in anesthesia.
After the patient is anesthetized, a sealed envelope containing computer a generated random assignment will be opened. Laryngoscopy will then be performed two times, with the Macintosh laryngoscope and with the AirTraq videolaryngoscope, in random order as determined by the envelope. Between laryngoscopies, the patient will be ventilated with sevoflurane in 100% oxygen.
Male patients will be intubated with an 8.0 mm inner diameter endotracheal tube (ETT) and women with a 7.0 mm or 7.5 mm ETT at the discretion of the anesthesiologist.
For AirTraq videolaryngoscopy, the AirTraq will be inserted and a view of the vocal cords will be obtained. The ETT will be advanced through the track until the tip of the ETT is visible at the glottic opening and then removed with the AirTraq videolaryngoscope.
For direct Macintosh laryngoscopy, a size 3 laryngoscope blade will be recommended in all patients, but the anesthesiologist may choose another size if deemed necessary. With laryngoscopy, the glottis will be exposed to enable positioning of the endotracheal tube at the vocal cords.
During the second laryngoscopy in the above sequence, the trachea will be intubated. The study is then complete. The hard board will be removed and the surgery will proceed in the usual fashion.
The laryngoscopy and intubation will be recorded by a portable fluoroscopy unit for subsequent review by the radiologist to assess cervical spine movement.
Laryngoscopy time will be defined as the time from when the laryngoscope blade or AirTraq videolaryngoscope passes the teeth of the patient until the time the endotracheal tube is positioned at the opening of the larynx. If the intubation sequence is longer than 120 seconds, it will be deemed a failure and recorded as such.
The Cormack-Lehane score, representing the degree of glottic exposure, of the larynx will be recorded for all patients. Blood oxygen saturation, heart rate, and blood pressure will be recorded every minute during the study.
To minimize inter-operator variability, all bag-mask ventilation, laryngoscopy, and intubation will be completed by one person.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 1 | Experimental | Device: AirTraqAir Traq then Macintosh |
| 2 | Experimental | Device: AirTraqMacintosh then AirTraq |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Elective non-cardiac surgery patients requiring intubation for the surgery.
- (Cardiac surgery uses TEE; there would not be space for the fluoroscopy machine.)
- ASA 1-3
- Body Mass Index (BMI) < 35
Key exclusion criteria (3 listed)
- patients with previous neck surgery or unstable C-spine
- patients with Reflux disease (GERD)
- patients who are or may be pregnant
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| AirTraqLaryngoscopy with AirTraq | Device | 1, 2 |
Primary outcome
Cervical Spine Movement
Time frame: Intubation
1 secondary outcome
Time to Intubation
Time frame: Intubation
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Oct 2008.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Timothy P Turkstra, MD principal investigator
Western University, Canada
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing AirTraq in people with Trauma, run by London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 16 Oct 2008. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cervical Spine Movement (time frame: Intubation). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2008.