title: Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
abstract: BACKGROUND
  Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts.
  
  
  METHODS
  Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems.
  
  
  RESULTS
  A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%), problematic initial tube positioning (n = 85, 24.5%), air leakage (n = 61, 17.6%), vomitus/aspiration (n = 44, 12.7%), and tube dislocation (n = 17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult".
  
  
  CONCLUSIONS
  We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@helse-bergen.no
authors.forename: Geir A
authors.initials: GA
authors.lastname: Sunde
authors.forename: Guttorm
authors.initials: G
authors.lastname: Brattebø
authors.forename: Terje
authors.initials: T
authors.lastname: Odegården
authors.forename: Dag F
authors.initials: DF
authors.lastname: Kjernlie
authors.forename: Emma
authors.initials: E
authors.lastname: Rødne
authors.forename: Jon-Kenneth
authors.initials: JK
authors.lastname: Heltne
mesh_terms: D000328:Adult; D058109:Airway Management / Q000295:instrumentation*; D001314:Auscultation; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D009664:Norway; D058687:Out-of-Hospital Cardiac Arrest; D053120:Respiratory Aspiration / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D014839:Vomiting / Q000150:complications