title: A comparison of the speed, success rate, and retention of rescue airway devices placed by first-responder emergency medical technicians: a high-fidelity human patient simulation study.
abstract: BACKGROUND
  Current airway management for most first-responder basic emergency medical technicians (EMT-Bs) does not include the use of blind-advanced-airway devices.
  
  
  OBJECTIVE
  To compare the speed, success rates, and skill retention with which EMT-Bs providers can place three blind-advanced-airway devices.
  
  
  METHODS
  Prospective study of 43 EMT-Bs trained in the use of the Esophageal-Tracheal-Combitube(®) (ETC), King LT(®) (KLT), and Laryngeal Mask Airway(™) (LMA). The time it took each participant to place each device correctly and ventilate a human patient simulator was assessed. Primary outcome measures were the success rate of proper insertion for each device and time interval from initiation of mouth insertion to initiation of chest rise. To assess skill retention, at 3 months the providers were reassessed under exact conditions.
  
  
  RESULTS
  At Day 1, time required to place an ETC, LMA, and KLT were 32.7 ± 12.3, 19.2 ± 6.2, and 20.1 ± 6.6 s, respectively. Using paired t-tests, LMA and KLT were faster than ETC, p < 0.0001. At 3 months, pair-wise comparisons showed the ETC took longer to place than the KLT and LMA, p < 0.0001; and the LMA took longer to place than the KLT, p = 0.0034 (36.4 ± 13.1 ETC, 24.8 ± 12.4 LMA, 19.0 ± 6.9 KLT). There was no statistical difference of failures in placing any device.
  
  
  CONCLUSIONS
  Comparison of three rescue airway devices placed by EMT-Bs providers showed that it takes significantly longer to place an ETC compared to an LMA and KLT both on Day 1 and 3 months later. Three-month retention studies revealed that it took significantly longer to place an LMA compared to the KLT.
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Voscopoulos
authors.forename: Tobias
authors.initials: T
authors.lastname: Barker
authors.forename: Todd
authors.initials: T
authors.lastname: Listwa
authors.forename: Steve
authors.initials: S
authors.lastname: Nelson
authors.forename: Charles
authors.initials: C
authors.lastname: Pozner
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Richard
authors.initials: R
authors.lastname: Zane
authors.forename: Jill A
authors.initials: JA
authors.lastname: Antoine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult