Comparing the efficacy of oral intubating airways to facilitate successful fiberoptic intubation: A systematic review

Background & rationale: In patients with difficult airways, fiberoptic bronchoscopes (FOB) are widely used to facilitate tracheal intubation. There are several oral intubating airways which can be used to orient the FOB towards the trachea during fiberoptic-guided intubation; however, it is unclear whether these are effective, and which provides the best intubation conditions. Objective: To systematically review the impact of airway intubators upon ease of intubation, length of procedure and quality of the bronchoscopic view. Setting: Fiberoptic intubation in any clinical setting including the operating room, emergency room, or intensive care unit. Methods: We conducted a systematic search of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Web of Science from 1981 to May 2022 to identify randomized control trials and observational studies, comparing use of airway intubators to no airway, or an alternative airway, in adult patients (age >16). We excluded non-english studies, cadaveric, and simulation studies. Results: We identified 1066 publications, of which 4 were eligible for inclusion in the review. The studies did not provide sufficient data to allow for meta-analysis. Across the four studies, the Williams Airway Intubator consistently provided a better bronchoscopic view and reduced procedural time in two of three studies; however, all of the studies were deemed to be at high risk of bias. Conclusions: The Williams Airway Intubator may be the most effective airway at providing quality bronchoscopic views, however, there does not appear to be any effect on rate of successful intubations. There is a need for well-designed randomized controlled trials to explore the effectiveness of different airway intubators in clinical practice.