AuraGain (TM) versus i-gel (TM) for bronchoscopic intubation under continuous oxygenation: A randomised controlled trial

Introduction: After failed mask ventilation and tracheal intubation, guidelines issued by the Difficult Airway Society recommend placing a second generation supraglottic airway device to secure oxygenation. Ultimately, a secure airway can be obtained by tracheal intubation through the supraglottic airway device using a bronchoscope. In this randomised trial, we compared the AuraGain (TM) with the i-gel (TM) as conduit for bronchoscopic intubation under continuous oxygenation performed by a group of anaesthesiologists with variable experience in a general population of patients. Method: We randomised one hundred patients who were equally allocated to flexible bronchoscopic intubation through the i-gel (TM) or the AuraGain (TM). In a random order, 25 anaesthesiologists each performed four intubations, two using the i-gel (TM) and two using the AuraGain (TM). Our primary outcome was 'total time for airway management'; i.e. total time from manually reaching the SAD to successful FBI confirmed at the end of the first inspiratory downstroke on the capnography curve. Results: In total, 87% (95% CI, 79%-92%) of the patients were successfully intubated through the allocated supraglottic airway device. There was no difference in total time for airway management between the i-gel (TM) and the AuraGain (TM) (199 vs. 227 s, p = .076). However, there was a difference in time for placement of the i-gel (TM), compared to the AuraGain (TM), (37 vs. 54 s, p < .001). There were nine failed intubations in the AuraGain (TM) group compared to four in the i-gel (TM) group (p = .147). Conclusion: We found no difference in total time for airway management between using the i-gel (TM) and using the AuraGain (TM).