Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes.
METHODS
Endotracheal intubation (ETI) is considered to be the gold standard of prehospital airway management. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers less experienced in ETI. We prospectively evaluated the feasibility of laryngeal tubes used by paramedics and emergency physicians for out-of-hospital airway management.


METHODS
During a 24-month period, all cases of prehospital use of the laryngeal tube disposable (LT-D) and laryngeal tube suction disposable (LTS-D) within five operational areas of emergency medical services were recorded by a standardised questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time and personal level of experience.


RESULTS
Of 157 prehospital intubation attempts with the LT-D/LTS-D, 152 (96.8%) were successfully performed by paramedics (n=70) or emergency physicians (n=87). The device was used as initial airway (n=87) or rescue device after failed ETI (n=70). The placement time was < or =45s (n=120), 46-90s (n=20) and >90s (n=7). In five cases the time needed was not specified. The number of placement attempts was one (n=123), two (n=25), three (n=2) and more than three (n=2). The majority of users (61.1%) were relative novices with no more than five previous laryngeal tube placements.


CONCLUSIONS
The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed.
Schalk
Richard
R
Clinic of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, J.W. Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Byhahn
Christian
C
Fausel
Felix
F
Egner
Andreas
A
Oberndörfer
Dieter
D
Walcher
Felix
F
Latasch
Leo
L
D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D002648:Child; D015331:Cohort Studies; D004209:Disposable Equipment / Q000706:statistics & numerical data; D004635:Emergency Medicine; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007440:Intubation / Q000295:instrumentation* / Q000706:statistics & numerical data; D007830:Larynx; D008875:Middle Aged; D010820:Physicians; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation*; D016896:Treatment Outcome