A simulator study of tube exchange with three different designs of double-lumen tubes

We sought to determine whether the design of 3 different double-lumen endobronchial tubes (DLT) (Rusch, Mallinckrodt, Fuji) has an effect on the ease of placement over an airway exchange catheter (AEC) using a video laryngoscope.

A convenience sample of 17 anesthesia residents and fellows with at least 3 years of anesthesia training was recruited from teaching hospitals in Toronto for a randomized crossover trial. Each participant passed each DLT over an AEC in an airway simulator, visualized and video recorded via a video laryngoscope (GlideScope). The order of exchange was randomized by blindly pulling the name of the manufacturer of a DLT from a box. The primary outcome was time to intubate, defined as time from the bronchial lumen entering the GlideScope view to the bronchial lumen passing the vocal cords. Also recorded were participants' subjective rating of the ease of use and failure rate, defined as an attempt >150-second duration.

Time to intubate was faster with the Fuji-Phycon DLT (median 2 seconds) compared with both the Rusch (median 27 seconds, P = 0.0144) and Mallinckrodt (median 21 seconds, P = 0.0117). On a scale of 1 to 10, with 10 being very easy to use and 1 being very difficult, the Fuji-Phycon was judged to be easier to use (median 10 seconds) compared with the Rusch (median 3, P = 0.0186) and the Mallinckrodt (median 4 seconds, P = 0.0123). The Rusch was associated with significantly more failures than the other DLTs, P = 0.002.

The Fuji-Phycon DLT was easier to pass over an AEC in this simulator trial and warrants consideration in patients with difficult airways who require 1-lung ventilation.