Eschmann introducer through laryngeal mask airway: a cadaveric trial of an alternate means of rescue intubation.
OBJECTIVE
Laryngeal mask airways (LMAs) are often used as airway rescue devices where laryngoscopy is difficult. The LMA does not protect the airway and is preferably replaced with a cuffed endotracheal tube. There are reports of cases where an Eschmann tracheal tube introducer (ETTI) was successfully used to bridge between a standard LMA and an endotracheal tube. This project was designed to determine whether an Eschmann stylet can reliably be passed through an LMA into the trachea as a means of rescue intubation.


METHODS
Nineteen emergency medicine residents and attending physicians, who were participants in a cadaveric airway course, placed and inflated a size 4 LMA (The Laryngeal Mask Company Ltd., San Diego, CA) on each of six unembalmed human cadavers in the usual fashion. They then attempted to pass a lubricated, 15 Fr, reusable, coude-tipped ETTI (Portex, Smiths Medical, Keene, NH)) through the airspace/handle of the inflated LMA. The LMA was then deflated and removed while the ETTI was held in place. Investigators then determined the location of the ETTI by laryngoscopy.


RESULTS
Of 114 attempts at the rescue procedure, 59 resulted in placement of the bougie into the trachea, yielding an overall success rate of 52% (95% CI 48%-56%). There were no significant differences in performance based on level of training of residents or years of experience of attending physicians.


CONCLUSIONS
While not a primary difficult airway option, the use of a ETTI as a bridge device between LMA and endotracheal tube was successful about 50% of the time.
Miller
Joel A
JA
Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Ft. Hood, TX.
Levsky
Marc E
ME
Givens
Melissa L
ML
Miller
Michael A
MA
Anaesthesia. 2005 Jun;60(6):626-7
15918844
J Emerg Med. 2003 Apr;24(3):267-70
12676295
Anaesthesia. 1996 Apr;51(4):389-90
8686831
Anesthesiology. 2004 Nov;101(5):1240; author reply 1242-4
15505469
Anaesthesia. 1989 Dec;44(12):1015
2619012
Anaesthesia. 1990 May;45(5):419-20
2356951
J Clin Anesth. 2001 Sep;13(6):427-9
11578886