A number of important limitations exist regarding this study. First, this is a manikin study, and these findings need to be confirmed and extended in clinical studies before definitive conclusions can be drawn. Nevertheless, our findings regarding the Airtraq® in manikin studies in other settings [8] have been confirmed in subsequent clinical studies [27,28], underlining the importance of the findings of this study. Second, we acknowledge that the potential for bias exists, as it is impossible to blind the AP’s to the device being used. Third, this study was

Inhibitors,research,lifescience,medical carried out in experienced users of the Macintosh laryngoscope. The findings may differ in studies of paramedics prior to their attaining competence with the Macintosh device. In this regard, a group Inhibitors,research,lifescience,medical of prehospital providers that had no previous training in performing tracheal intubation demonstrated high levels of success with the Airtraq® [29]. In a separate study from this same group of investigators, a group of third year paramedic students and a group of experienced prehospital laryngoscopists each had increased first-time Inhibitors,research,lifescience,medical intubation rates and lower rates of oesophageal intubation with the Airtraq® compared with the Macintosh

laryngoscope, in a manikin model of difficult tracheal intubation [6]. Fourth, we defined a maximal permissible duration of tracheal intubation attempts of 60 seconds. A 30 second breath-to-breath interval is widely considered to be the maximum Inhibitors,research,lifescience,medical permissible duration of a tracheal intubation attempt in the pre-hospital click here setting. Fifth, although the study is adequately powered to detect the primary outcome, namely differences in the duration of tracheal intubation attempts, the sample size is relatively small Inhibitors,research,lifescience,medical and may therefore be subject to bias, and may not have been sufficient to detect secondary outcomes. Finally, the relative efficacies

of these devices in comparison to other promising devices such as the Glidescope® [30], McCoy® [31], McGrath® [32] or Bonfils® [33] have not been determined. We focussed on the Airtraq® and Truview® in this study due to the fact that these are relatively low cost, portable devices that can easily be included in the equipment used by AP’s. Nevertheless, whatever further comparative studies are needed with other alternative laryngoscopy devices in order to find the optimal alternatives to the Macintosh laryngoscope. Conclusion We conclude that the Airtraq® laryngoscope may possess certain advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios. The Airtraq® laryngoscope constitutes a promising alternative device to the Macintosh for use by AP’s. In contrast, the Truview® performed less well, and does not demonstrate promise in this context.