title: Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes.
abstract: 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.
authors.affiliation: Clinic of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, J.W. Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Schalk
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Felix
authors.initials: F
authors.lastname: Fausel
authors.forename: Andreas
authors.initials: A
authors.lastname: Egner
authors.forename: Dieter
authors.initials: D
authors.lastname: Oberndörfer
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.forename: Leo
authors.initials: L
authors.lastname: Latasch
mesh_terms: 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