Novices ventilate and intubate quicker and safer via intubating laryngeal mask than by conventional bag-mask ventilation and laryngoscopy.
BACKGROUND
Because airway management plays a key role in emergency medical care, methods other than laryngoscopic tracheal intubation (LG-TI) are being sought for inadequately experienced personnel. This study compares success rates for ventilation and intubation via the intubating laryngeal mask (ILMA-V/ILMA-TI) with those via bag-mask ventilation and laryngoscopic intubation (BM-V/LG-TI).


METHODS
In a prospective, randomized, crossover study, 30 final-year medical students, all with no experience in airway management, were requested to manage anesthetized patients who seemed normal on routine airway examination. Each participant was asked to intubate a total of six patients, three with each technique, in a randomly assigned order. A task not completed after two 60-s attempts was recorded as a failure, and the technique was switched.


RESULTS
The success rate with ILMA-V was significantly higher (97.8% vs. 85.6%; P < 0.05), and ventilation was established more rapidly with ILMA-V (35.6 +/- 8.0 vs. 44.3 +/- 10.8 s; P < 0.01). Intubation was successful more often with ILMA-TI (92.2% vs. 40.0%; P < 0.01). The time needed to achieve tracheal intubation was significantly shorter with ILMA-TI (45.7 +/- 14.8 vs. 89.1 +/- 23.3 s; P < 0.01). After failed LG-TI, ILMA-V was successful in all patients, and ILMA-TI was successful in 28 of 33 patients. Conversely, after failed ILMA-TI, BM-V was possible in all patients, and LG-TI was possible in 1 of 5 patients.


CONCLUSIONS
Medical students were more successful with ILMA-V/ILMA-TI than with BM-V/LG-TI. ILMA-TI can be successfully used when LG-TI has failed, but not vice versa. These results suggest that training programs should extend the ILMA to conventional airway management techniques for paramedical and medical personnel with little experience in airway management.
Timmermann
Arnd
A
Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Germany. atimmer@zari.de
Russo
Sebastian G
SG
Crozier
Thomas A
TA
Eich
Christoph
C
Mundt
Birgit
B
Albrecht
Bjoern
B
Graf
Bernhard M
BM
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D017214:Laryngeal Masks / Q000009:adverse effects; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D013337:Students, Medical