title: Emergency airway management in trauma patients using laryngeal tube suction.
abstract: BACKGROUND
  Endotracheal intubation (ETI) is considered to be the "gold standard" of prehospital airway management of trauma patients. 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 who are less experienced in ETI.
  
  
  OBJECTIVE
  To prospectively evaluate the feasibility of the use of laryngeal tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients.
  
  
  METHODS
  During a 40-month period, data for all cases of prehospital use of the laryngeal tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up.
  
  
  RESULTS
  Fifty-six of 57 prehospital intubations attempts with the LTS-D were successfully performed by paramedics (n = 19) or emergency physicians (n = 37) within one (n = 50) or two (n = 6) placement attempts. The device was used as initial airway (n = 27) or rescue device after failed ETI (n = 30). The placement time was ≤ 45 seconds (n = 42), 46-90 seconds (n = 13), and >90 seconds (n = 1). The majority of users (n = 44) were relative novices with no more than 10 previous laryngeal tube placements on actual patients. Of 33 patients eligible for follow-up, one underwent urgent LTS-D removal and subsequent ETI upon hospital admission, six underwent ETI after primary survey, and 26 underwent both primary and secondary survey or even damage-control surgery with the LTS-D.
  
  
  CONCLUSIONS
  The LTS-D represents a promising alternative to ETI 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 in ETI, or as a rescue device when ETI has failed.
authors.affiliation: Clinic of Anesthesiology, Intensive Care Medicine, and Pain Therapy, JW Goethe University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Schalk
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.forename: Miriam
authors.initials: M
authors.lastname: Ruesseler
authors.forename: Dieter
authors.initials: D
authors.lastname: Oberndörfer
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.forename: Leo
authors.initials: L
authors.lastname: Latasch
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
mesh_terms: D058109:Airway Management / Q000379:methods; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013396:Suction; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000628:therapy*