title: Intubating laryngeal mask airway versus laryngoscopy and endotracheal intubation in the nuclear, biological, and chemical environment.
abstract: OBJECTIVE
  Intubation is a difficult skill under normal circumstances and more so with a limited visual field such as wearing a protective mask in a chemical or biological incident. This study sought to determine whether successful intubation using the intubating laryngeal mask airway (ILMA) under protective mask conditions was equivalent to standard endotracheal intubation.
  
  
  METHODS
  A pilot study was conducted using emergency medicine personnel. Participant's attempted intubation of a manikin while wearing a standard U.S. Army M-40 protective mask. Two attempts were performed with each method.
  
  
  RESULTS
  One hundred percent of the ILMA placements were successful with only 78% success with endotracheal intubation (p = 0.1). Time to successful intubation and ventilation was significantly less for the ILMA versus endotracheal intubation (p = 0.005).
  
  
  CONCLUSIONS
  This study suggests that under simulated chemical and biological conditions using an M-40 protective mask, intubation is accomplished faster and with more success with the ILMA.
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center-University of Washington Emergency Medicine Residency, Fort Lewis, WA 98234, USA.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Wedmore
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Talbo
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cuenca
mesh_terms: D001694:Biological Warfare; D002618:Chemical Warfare; D004636:Emergency Service, Hospital; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy; D009689:Nuclear Warfare; D010865:Pilot Projects; D011446:Prospective Studies; D012134:Respiratory Protective Devices