Use of the Totaltrack^® Video Laryngeal Mask Airway for tracheal intubation: A feasibility study

Background: According to both national and international difficult airway guidelines, supraglottic airway devices (SGADs) can be used as either ventilatory devices or as intubation conduits, if tracheal intubation is desired. The Totaltrack^® VLM was recently developed as a second-generation SGAD that allows continuous visualization, uninterrupted oxygenation, and positive pressure ventilation during both intubation and extubation. Aim: To evaluate the functionality and ease of use of the Totaltrack^® VLM regarding the adequacy of oxygenation during tracheal intubation under continuous visualization and ventilation. Methods: Following IRB approval, thirty adult (>18 yo) patients, with Mallampati classifications I-III and mouth openings > 2 cm, scheduled for elective surgery requiring general anesthesia and tracheal intubation were included in this study. In order to assess the feasibility and performance of the Totaltrack^® VLM, various measurements were collected, including lowest oxygen saturation (SpO₂) during the intubation procedure, number of attempts required to intubate, time taken until CO₂ detection and intubation, and a subjective assessment describing the level of difficulty of the intubation process (1 Very Easy - 5 Not Possible). Results: The Totaltrack^® VLM was successfully placed and facilitated tracheal intubation in 25 patients (83.3%, 95% confidence interval: 65.3%–94.4%) during the first intubation attempt. The minimum SpO₂ was 98.5% ± 4.3% (mean ± SD) during Totaltrack^® VLM intubation. The median time required for initial ventilation, for all 30 patients, was 16.1s. The median time required for the entire intubation procedure and a successful intubation was 34.3s and 13.9s, respectively. The median ease-of-use score for laryngoscopy, intubation, and overall use, was Easy (2), as measured by a numeric rating scale (NRS) with an interquartile range of 1–3, based on the total 30 patients. The Totaltrack^® VLM provided an overall intubation success rate of 93.3% (95% CI: 77.9%-99.2), with an overall ventilation success rate of 100%. Conclusion: This study demonstrated that the Totaltrack^® VLM provided satisfactory functionality as a ventilatory device and intubation conduit, while adequately oxygenating patients during tracheal intubation. However, considering the novelty of this particular study, further research is warranted, to determine its usefulness in patients with known or predicted difficult airways.