Face-to-face videolaryngoscopy for tracheal intubation in microgravity

Abstract Long-duration space missions will require crews to manage medical emergencies autonomously, including airway management in microgravity. In weightlessness, the lack of gravitational reference alters operator–patient orientation and may complicate procedures such as tracheal intubation, particularly for operators with limited airway experience. We conducted a crossover study during parabolic flights generating repeated periods of microgravity. Six novice operators performed 135 tracheal intubation attempts on an airway manikin using either a face-to-face Airtraq® videolaryngoscopy configuration (AIR-F2F) or a conventional behind-the-head McGrath® videolaryngoscopy approach (MG-CONV). Outcomes were analyzed using mixed-effects models accounting for repeated measurements. AIR-F2F achieved a higher success rate than MG-CONV (90.3% vs. 63.0%). The odds of successful intubation were significantly higher with AIR-F2F (odds ratio 6.4, 95% CI 2.3–18.0; P < 0.001). Intubation was faster and perceived as less difficult with AIR-F2F, whereas glottic visualization was similar between techniques. These findings suggest that operator–patient orientation may influence airway management performance in microgravity and could inform the design of airway management procedures for future autonomous space missions.