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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Galeiras V&#225;zquez et al&#46; make an excellent review of post-traumatic spinal cord injuries&#44; but we do not agree on the recommendation to use first the Airtraq<span class="elsevierStyleSup">&#174;</span> device as an alternative to direct laryngoscopy&#44; or the statement that there is a lack of evidence confirming the utility of other devices&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">They stand for the use of Airtraq<span class="elsevierStyleSup">&#174;</span> in one meta-analysis of 24 trials that compared different devices that may be an alternative to the Macintosh laryngoscope blade&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In all the trials&#44; the operator is an experienced anesthesiologist&#44; and there are zero patients with difficult intubations &#8211; something that could be expected&#44; included in the trials&#59; both facts are far from the actual clinical scenario of post-traumatic spinal cord injuries&#58; polytraumas that require the isolation of the airway in the extra-hospital setting&#44; or hospital emergency services by doctors who are not anesthesiologists&#59; and that require urgent care which&#44; given their adverse physiological conditions&#44; makes patient&#39;s airway extremely difficult to handle&#46; Also&#44; an obvious limitation reported in this device and video laryngoscopes&#44; in general&#44; is the loss of visualization due to the blood and secretions occupying the lens &#8211; a common thing in these patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Contrary to all this&#44; the Fastrach&#8482; intubating laryngeal mask is widely used in all extra-hospital and hospital ERs&#44; and there are multiple studies confirming high rates of success in the ventilation and blind intubation procedures performed by medical sand non-medical staff with and without prior training&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Out of the 24 trials included in the aforementioned meta-analysis&#44; only the study conducted by Gercek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> includes the Fastrach&#8482; and shows less movement of the cervical spine and shorter intubation times than what has been reported with direct laryngoscopy procedures&#44; while exposing its utility for the management of airways after spinal cord injuries&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So far&#44; the reviews that advise against the use of supragottic devices while managing potential or confirmed cervical spinal cord injuries are based on the conclusions drawn by a study conducted by Keller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> that shows an increased pressure against the cervical vertebrae&#46; The study included 20 cadavers but&#44; as the authors say&#44; the model cannot be extrapolated to physiological conditions due to the lower temperature and higher rigidity of the pharyngeal musculature&#46; We should add here that in all cadavers&#44; the size 5 Fastrach&#8482; blade was used &#40;recommended for patients weighing around 70&#8211;100<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; when the authors describe that their study population weight was in the 50&#8211;93<span class="elsevierStyleHsp" style=""></span>kg range&#46; This means that there is an undetermined number of cases where bigger sizes are being used with the corresponding risk of tissue lesion&#44; and intubation failure&#44; and probably another contributing factor for the negative results reported in such study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that the Fastrach&#8482; intubating laryngeal mask is a safe and widely used device that can be used for ventilation and intubation of patients with suspected or confirmed cervical spinal cord injuries&#46;</p></span>"
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Letter to the Editor
Fastrach™ Intubating Laryngeal Mask for traumatic cervical spinal cord injury
Mascarilla laríngea para intubación Fastrach™ en la lesión medular cervical postraumática
F.R. Pampín Huerta
Corresponding author
franpampin@yahoo.es

Corresponding author.
, D. Moreira Gómez, V. Rodríguez López
Unidad de Reanimación y Cuidados Intensivos, Hospital HM Modelo, A Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Galeiras V&#225;zquez et al&#46; make an excellent review of post-traumatic spinal cord injuries&#44; but we do not agree on the recommendation to use first the Airtraq<span class="elsevierStyleSup">&#174;</span> device as an alternative to direct laryngoscopy&#44; or the statement that there is a lack of evidence confirming the utility of other devices&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">They stand for the use of Airtraq<span class="elsevierStyleSup">&#174;</span> in one meta-analysis of 24 trials that compared different devices that may be an alternative to the Macintosh laryngoscope blade&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In all the trials&#44; the operator is an experienced anesthesiologist&#44; and there are zero patients with difficult intubations &#8211; something that could be expected&#44; included in the trials&#59; both facts are far from the actual clinical scenario of post-traumatic spinal cord injuries&#58; polytraumas that require the isolation of the airway in the extra-hospital setting&#44; or hospital emergency services by doctors who are not anesthesiologists&#59; and that require urgent care which&#44; given their adverse physiological conditions&#44; makes patient&#39;s airway extremely difficult to handle&#46; Also&#44; an obvious limitation reported in this device and video laryngoscopes&#44; in general&#44; is the loss of visualization due to the blood and secretions occupying the lens &#8211; a common thing in these patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Contrary to all this&#44; the Fastrach&#8482; intubating laryngeal mask is widely used in all extra-hospital and hospital ERs&#44; and there are multiple studies confirming high rates of success in the ventilation and blind intubation procedures performed by medical sand non-medical staff with and without prior training&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Out of the 24 trials included in the aforementioned meta-analysis&#44; only the study conducted by Gercek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> includes the Fastrach&#8482; and shows less movement of the cervical spine and shorter intubation times than what has been reported with direct laryngoscopy procedures&#44; while exposing its utility for the management of airways after spinal cord injuries&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So far&#44; the reviews that advise against the use of supragottic devices while managing potential or confirmed cervical spinal cord injuries are based on the conclusions drawn by a study conducted by Keller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> that shows an increased pressure against the cervical vertebrae&#46; The study included 20 cadavers but&#44; as the authors say&#44; the model cannot be extrapolated to physiological conditions due to the lower temperature and higher rigidity of the pharyngeal musculature&#46; We should add here that in all cadavers&#44; the size 5 Fastrach&#8482; blade was used &#40;recommended for patients weighing around 70&#8211;100<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; when the authors describe that their study population weight was in the 50&#8211;93<span class="elsevierStyleHsp" style=""></span>kg range&#46; This means that there is an undetermined number of cases where bigger sizes are being used with the corresponding risk of tissue lesion&#44; and intubation failure&#44; and probably another contributing factor for the negative results reported in such study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that the Fastrach&#8482; intubating laryngeal mask is a safe and widely used device that can be used for ventilation and intubation of patients with suspected or confirmed cervical spinal cord injuries&#46;</p></span>"
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