Use of the intubating laryngeal mask airway in emergency pre-hospital difficult intubation.
OBJECTIVE
While several techniques are used for the management of difficult intubation (DI) in planned conditions in the operating theatre, they are not always suitable or usable in pre-hospital emergencies. We decided to assess the intubating laryngeal mask airway (ILMA) after failure of tracheal intubation (TI) under direct laryngoscopy.


METHODS
After emergency physicians of the mobile intensive care unit were trained (theory and training on manikin) in using the ILMA (Fastrach), prospective data were collected after each use from March 2002 to December 2005. Data included patient's age, clinical status, number of direct laryngoscopies before using ILMA, Cormack and Lehane grade, subjective and objective evaluation of ease of ILMA insertion and TI (analogue scale from 1 to 10, attempts required, failure rate).


RESULTS
Over 46 months, the ILMA was used 45 times (24: cardio-respiratory arrest, 21: anaesthesia with rapid sequence induction). Median age was 59 years [range 20-86]. The number of direct laryngoscopy attempts was 3 [0-4] (76% Cormack 4). The success of ILMA insertion and TI were 96 and 91%, respectively.


CONCLUSIONS
Emergency physicians were satisfied with using the ILMA. It allowed TI in 91% of cases of DI. The ILMA can be recommended to be included in the algorithm of DI in pre-hospital emergencies after initial training.
Tentillier
Eric
E
SAMU 33, Department of Emergency SAMU-SMUR, Pellegrin Hospital, 33076 Bordeaux Cedex, France. eric.tentillier@chu-bordeaux.fr
Heydenreich
Claire
C
Cros
Anne-Marie
AM
Schmitt
Valérie
V
Dindart
Jean-Michel
JM
Thicoïpé
Michel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000758:Anesthesia / Q000379:methods*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome