title: Use of the intubating laryngeal mask airway by medical and nonmedical personnel.
abstract: The intubating laryngeal mask airway (ILMA) is a newly available device designed to allow for blind endotracheal intubation and treatment of patients with difficult airways. We studied the intubation success rates and speed with initial use of this device on an intubation manikin to determine whether this device might be easily used by trained and untrained personnel. Rapid and successful intubation with a device requiring limited or no training could have widespread implications for both health care providers and laypersons. The study consisted of 2 parts. In part 1, health care providers with intubation experience, health care providers without prior intubation experience, and nonmedical personnel were instructed to enter a room and intubate a manikin using the ILMA. A single page set of schematic directions was provided within the ILMA setup. The main outcomes were the intubation success rate and the time required for successful ventilation and intubation. In part 2, participants were retested after a standardized <60 second device demonstration. The 111 participants in the study included 44 emergency physicians (40%), 21 anesthesiologists (19%), and 46 other medical or nonmedical personnel (41%). On first attempted use of the device, and with no prior training, 59% of all participants successfully intubated the manikin. Attending and resident physicians had an 83% initial success rate. The median time to ventilation was 47 seconds, and the median time from ventilation until intubation was 29 seconds. Following the <60 second demonstration, 108 of 111 (97%) participants achieved success, with the median time to ventilation 18 seconds, and the median time from ventilation until intubation 17 seconds. All attending and resident physicians succeeded in intubation following the demonstration. Success rates on first attempt correlated with level of training, prior intubation experience, and prior LMA use (all P < .001). After a <60 second demonstration, medical and nonmedical personnel with and without prior intubation training can successfully use the ILMA to rapidly establish an airway in a manikin model. The ILMA should be further studied to determine if it may permit endotracheal intubation by first responders, paramedical personnel, and other medical staff with limited or no laryngoscopy skills.
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA. levitanr@mail.med.upenn.edu
authors.forename: R M
authors.initials: RM
authors.lastname: Levitan
authors.forename: E A
authors.initials: EA
authors.lastname: Ochroch
authors.forename: S
authors.initials: S
authors.lastname: Stuart
authors.forename: J E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017214:Laryngeal Masks; D008348:Manikins; D008502:Medical Secretaries / Q000193:education*; D008505:Medical Staff, Hospital / Q000193:education*; D009741:Nursing Staff, Hospital / Q000193:education*; D013997:Time Factors; D016896:Treatment Outcome