Reply to Letter: Is Airtraq^® optical laryngoscope a high-efficiency device for emergent tracheal intubation during infant chest compression?

First, we would like to thank Dr. Xue and colleagues for their interest in our recent manuscript. It is possible that preparation of the Airtraq^® (ATQ; Prodol Meditec, Vizcaya, Spain) requires time to open the package, lubricate the tracheal tube and load the tube to the guiding channel. However, we would point out that preparation of the Miller laryngoscope (Mil) also requires preparation time to connect and check the blade and laryngoscope, lubricate the tracheal tube and insert the stylet. The European Resuscitation Council (ERC) cardiopulmonary resuscitation (CPR) guidelines emphasize delivery of continuous chest compression with as few interruptions as possible, including pauses for airway management efforts. Thus, the primary aim of our study design was to evaluate success rates for the ATQ and Mil with regard to definite tracheal intubation during uninterrupted infant chest compression. Regarding the limitation of this simulation study, because no previous study was available and the assumed situation was extremely critical, it would be ethical to begin with a simulation study with a manikin. In contrast to the randomized study they cited of adult tracheal intubation in prehospital emergency settings, our study design pertained to infant tracheal intubation during chest compression, which is completely different. Strengths and weaknesses of ATQ with regard to emergent tracheal intubation will undoubtedly vary between infant and adult cases.^,  Finally, with regard to utilization of the stylet, we used it in tracheal intubation with Mil. Application of a stylet is essential in the Mil trial to control the direction of passage of size 3.0 tracheal tube. Under these conditions, the success rate for infant tracheal intubation was higher in the ATQ trials than Mil. As we describe in the manuscript, clinical accumulation and randomized trials of ATQ or other video or optic laryngoscope vs. Mil application in infants receiving CPR in clinical situations are needed for further evaluation.