AirSPACE™ device for real-time positioning during laryngoscopy

Abstract Background Patient positioning is critical in establishing an optimal laryngeal view during various airway management techniques, including direct laryngoscopy. The "sniffing" position, in which all 3 axes are aligned, has been the traditional method for direct laryngoscopy. [1, 2] The AirSPACE™ is a new positioning device that was developed to facilitate patient positioning during laryngoscopy via mechanical head and neck manipulation, potentially improving the visualization of laryngeal structures. Aim The purpose of this study was to evaluate the performance of the AirSPACE™ device, as measured by the percentage of the Modified Cormack-Lehane (C-L) classification system, Grade's III or IV specifically, for glottic visualization during the first attempt of laryngoscopy and intubation. Methods Following IRB approval, 30 adult (≥18 y/o) patients with ASA status classifications I-III, requiring tracheal intubation and general anesthesia, participated in this study. In order to assess the performance of the device, various measurements were obtained, including the initial C-L airway grade view during the first attempt, the C-L grade view after repositioning (if necessary), the time required for patient repositioning, the time required to obtain an optimal view of the glottis and CO 2 detection, the time required to fully set up the AirSPACE™ device onto the designated OR table, the number of attempts required for a successful intubation, the minimum oxygen saturation (SpO 2 ) while the airway was being secured, the method of laryngoscopy performed, subjective assessment evaluations from utilizing the AirSPACE™, and safety reporting of any adverse events. Results Of the 30 patients enrolled in the study, only 3 (10.0%, 95% confidence interval: 2.1%–26.5%) were recorded with a C-L Grade III or IV, with an average repositioning time of 29.3 ± 8.4s. The frequency of initial C-L grade views was: I, 50.0%; IIa, 16.7%; IIb, 23.3%; III, 6.7%; and IV, 3.3%. For the 3 patients who required repositioning, 2 demonstrated improvement in the glottic view after repositioning, while one demonstrated no improvement. The time required to obtain an optimal view of the glottis and that for CO 2 detection was 19.7 ± 13.8s and 42.6 ± 22.0s, respectively. The average time required to set up the AirSPACE™ device was 4.29 ± 1.81 min. The average minimum oxygenation during intubation was 99.7± 0.6%. Direct laryngoscopy (90%) was the preferred method when performing laryngoscopy and intubation, when compared to indirect (10%) during the study period. Nearly half of the laryngoscopists assessed the difficulty of laryngoscopy and difficulty of ETT delivery as 1 ( Very Easy ), 43.3% and 46.7%, respectively, whereas 68.8% assessed AirSPACE™ device ease of use as 1 ( Very Easy ). Conclusion This study demonstrated that the AirSPACE™ device is an effective positioning mechanism that provided the laryngoscopist with a highly favorable glottic view initially. Yet, further research is warranted in evaluating the AirSPACE™'s effectiveness in improving glottic visualization of less favorable and more difficult airways on a much larger spectrum.