Letter to the Editor: Optimal device for emergency intubation - a commentary on the complementary role of intubating laryngeal mask airway-video laryngoscope

Abstract

The randomized controlled trial by Aggarwal et al recently published in World Journal of Critical Care Medicine, compared the intubating laryngeal mask airway (ILMA) with the Camera Macintosh video laryngoscope (VL) for emergency intubation in critically ill adults. In this randomized cohort of 58 patients, the VL demonstrated a higher first-attempt success rate, shorter intubation time, and superior glottic visualization compared to the ILMA. However, the role of the ILMA in specific high-risk scenarios warrants continued consideration. Adverse events were comparable between the two devices. The VL appears preferable as the primary device for emergency airway management, while the ILMA serves as an effective rescue option. Additionally, the ILMA remains useful in cases of restricted mouth opening and difficult airway scenarios.

Keywords: Emergency airway management; Video laryngoscopy; Laryngeal masks; Intubation; Intratracheal; Critical illness; Cervical immobilization

Core Tip: In emergency airway management, video laryngoscopy (VL) consistently provides higher first-pass success rates and faster intubation when visualization is reliable. However, its effectiveness decreases significantly in contaminated airways or when neck movement must be minimized. In these situations, the intubating laryngeal mask airway (ILMA) remains a valuable complementary device, allowing continued oxygenation, minimal cervical manipulation, and reliable intubation even without visual guidance. Rather than considering VL universally superior, clinicians should integrate both devices into airway management strategies-selecting VL for clear, stable conditions and ILMA for unstable, hypoxic, immobilized, or contaminated airways.