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

Table 1 Comparison of intubating laryngeal mask airway vs video laryngoscope for emergency intubation

Parameter	Intubating laryngeal mask airway	Video laryngoscope
First-attempt success rate	Moderate; improves with operator experience. Some studies, including those on manikins and humans, show lower first-pass success rates with video laryngoscopes[2,6,7]	Generally, there is a higher first-attempt success rate, consistently superior in comparative studies involving both manikins and humans[2-5]
Overall intubation success	High success rates are observed when fiberoptic assistance is used or multiple attempts are allowed[6-8]	Very high; strong evidence indicates improved overall success compared to the intubating laryngeal mask airway and direct laryngoscope[3-5]
Time to intubation	The procedure takes longer due to device insertion and tube advancement[2,6]	Shorter, particularly when good glottic visualization is achieved[2,3,8]
Restricted cervical spine mobility/trauma cases	Advantageous because it requires minimal neck movement and is effective even with manual in-line stabilization[6]	Effective but may still require some alignment; performance depends on the model[3,5]
Airway visualization	Blind unless fiberoptic used[7,9]	Excellent real-time visualization, particularly for challenging glottic views[3,4,9]
Usefulness in contaminated airway (blood/vomit)	More reliable because visualization is not required[6,7]	Visualization may be impaired by secretions, fogging, or blood[3,4]
Oxygenation during intubation	Possible continuous oxygenation and ventilation via the intubating laryngeal mask airway conduit[6,7]	Limited ability to oxygenate during intubation[3]
Ease of insertion	Simple insertion; however, there is a steep learning curve for blind intubation[6,7]	Moderately easy, but requires familiarity with video screen operation and angulation[3,5]
Complication rate	Lower dental trauma; occasional sore throat or epiglottic downfolding[6,7]	Possible mucosal injury, dental trauma, or soft tissue compression may occur[3,5]
Performance in obese patients	Effective; however, multiple attempts may be required[8]	High success rates and clear visualization have been demonstrated even in obese patients; airtraq and Camera Macintosh devices were studied[8]
Role in failed intubation	An excellent rescue device that facilitates oxygenation and intubation through a conduit[6,7]	Useful but not always ideal for rescue if visualization is obscured[3,4]
Ideal use scenario	Difficult airway, cervical immobilization, and failed laryngoscopy[6,7]	Emergency airway management requires the highest first-pass success rate[3-5]