Elsevier

Resuscitation

Volume 81, Issue 3, March 2010, Pages 323-326
Resuscitation

Clinical paper
Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes,☆☆

https://doi.org/10.1016/j.resuscitation.2009.11.007Get rights and content

Abstract

Concept

Endotracheal intubation (ETI) is considered to be the gold standard of prehospital airway management. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers less experienced in ETI. We prospectively evaluated the feasibility of laryngeal tubes used by paramedics and emergency physicians for out-of-hospital airway management.

Material and methods

During a 24-month period, all cases of prehospital use of the laryngeal tube disposable (LT-D) and laryngeal tube suction disposable (LTS-D) within five operational areas of emergency medical services were recorded by a standardised questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time and personal level of experience.

Results

Of 157 prehospital intubation attempts with the LT-D/LTS-D, 152 (96.8%) were successfully performed by paramedics (n = 70) or emergency physicians (n = 87). The device was used as initial airway (n = 87) or rescue device after failed ETI (n = 70). The placement time was ≤45 s (n = 120), 46–90 s (n = 20) and >90 s (n = 7). In five cases the time needed was not specified. The number of placement attempts was one (n = 123), two (n = 25), three (n = 2) and more than three (n = 2). The majority of users (61.1%) were relative novices with no more than five previous laryngeal tube placements.

Conclusion

The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed.

Section snippets

Material and methods

During a 24-month period, a cohort study was performed, during which all prehospital intubations with either the laryngeal tube disposable or the laryngeal tube suction disposable (LT-D and LTS-D, VBM Medizintechnik GmbH, Sulz a.N., Germany) performed by paramedics and emergency physicians were recorded by means of a standardised questionnaire, which was approved by the institutional review board. The operational areas of the emergency medical services (EMS) consisted of the German metropolitan

Results

During a 24-month period, 155 adults (mean age 60 ± 17 years, mean body mass index 30 ± 6 kg m−2) and two children aged 9 months and 7 years underwent emergency management airway with either the LT-D (n = 19) or the LTS-D (n = 138). According to the manufacturer's instructions for use, the LT-D/LTS-D sizes used were size 5 (n = 96), size 4 (n = 58), size 3 (n = 2) and size 0 (n = 1). The indications for airway management are shown in Table 2.

Compared with paramedics, who used the LT-D/LTS-D significantly more

Discussion

The results of our study show that the LT-D/LTS-D was effective in managing the airway in out-of-hospital environments by both emergency physicians and paramedics. In 94.3% of the cases, the laryngeal tube could be placed within two attempts. In only five out of 157 patients, laryngeal tube placement failed, and the patients underwent either endotracheal intubation or cricothyrotomy. Establishing an airway failed completely in only one out of 157 patients (0.6%), in whom bag-valve-mask

Conflict of interest

None of the authors has any conflict of interest with devices and/or companies mentioned in the article or with potentially competing devices and/or companies.

Acknowledgement

The authors would like to thank all paramedics and emergency physicians of the participating emergency medical services for their efforts and support during this study. Our particular thanks are due to: Ralf Peter Feuster, MD, Jennifer Fries, RN, Rolf Kirchner, MD, Dirk Meininger, MD, Norman Peter, RN, Bertram Scheller, MD, and Elvira Wenzel, RN, Clinic of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University of Frankfurt, Germany; Kai Rüttger, MD and Sophie Wetzel, MD,

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.11.007.

    ☆☆

    The study was presented in part during the Annual Meeting of the German Society of Anaesthesiologists, Leipzig, Germany, 11 May 2009.

    1

    These authors contributed equally to the study.

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