title: Paramedic tracheal intubation using the intubating laryngeal mask airway.
abstract: OBJECTIVE
  Tracheal intubation through the intubating laryngeal mask airway (ILMA) has been evaluated, in controlled settings, as an acceptable alternative to laryngoscopic intubation. Our observational study was designed to examine the success rate of tracheal intubation using the ILMA in the prehospital setting after mannequin-based training.
  
  
  METHODS
  We examined all oral tracheal intubations performed by the Tasmanian Ambulance Service (TAS) from April 2005 to April 2006. TAS paramedics are occasional intubators, as defined in the study by Reeves et al.,(8) on average performing two intubations per paramedic per year. Fifty-eight paramedics received training in tracheal intubation through the ILMA. The primary outcome measure was tracheal intubation success. Our hypothesis was that paramedics would be able to successfully perform out-of-hospital tracheal intubation using the ILMA with minimal training.
  
  
  RESULTS
  During the study period, 106 patients had out-of-hospital tracheal intubation performed by ambulance paramedics. Comparisons were made between the intubations with the ILMA and by laryngoscopy. The overall intubation success rate was 91% with the laryngoscope and 92% with the ILMA. The success rate for the first attempt at intubation was higher with the ILMA (81%) than with direct laryngoscopy (57%) (RR (95% CI): 1.74 (95% CI: 1.18-2.59, p = 0.009), regardless of ultimate success. The success rate when intubating unconscious patients using the ILMA was significantly higher (88%) than intubation using the laryngoscope (63%). These intubations were achieved without the administration of any sedation or paralytic medication.
  
  
  CONCLUSIONS
  Intubation via the ILMA was as successful as conventional laryngoscopic intubation, requiring fewer attempts, although this was not statistically significant.
authors.affiliation: The North West Regional Hospital, Tasmania. mmc11286@bigpond.net.au
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McCall
authors.forename: Mark
authors.initials: M
authors.lastname: Reeves
authors.forename: Marcus
authors.initials: M
authors.lastname: Skinner
authors.forename: Corinne
authors.initials: C
authors.lastname: Ginifer
authors.forename: Paul
authors.initials: P
authors.lastname: Myles
authors.forename: Noel
authors.initials: N
authors.lastname: Dalwood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D017214:Laryngeal Masks; D008348:Manikins; D008875:Middle Aged; D011446:Prospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data; D013648:Tasmania