title: Complications associated with the prehospital use of laryngeal tubes--a systematic analysis of risk factors and strategies for prevention.
abstract: OBJECTIVE
  With the increasing spread of laryngeal tubes (LT) in emergency medicine, complications and side-effects are observed. We sought to identify complications associated with the use of LTs in emergency medicine, and to develop strategies to prevent these incidents.
  
  
  METHODS
  In a prospective clinical study, all patients who had their airways managed in the field with a LT and who were admitted through the emergency department of the Frankfurt University Hospital during a 6 year period were evaluated using anonymised data collection sheets. A team of experts was available 24/7 and was requested whenever a patient was admitted with a LT in place. This team evaluated the condition of the patients with respect to prehospital airway management and was responsible for further advanced airway management. All complications were analysed, and strategies for prevention developed.
  
  
  RESULTS
  One hundred eighty nine patients were included and analysed. The initial cuff pressure of the LTs was 10 0 cm H₂O on the median. Complications consisted of significant tongue swelling (n=73; 38.6%), resulting in life-threatening cannot ventilate, cannot intubate scenarios in two patients (1.0%) and the need for surgical tracheostomy in another patient, massive distension of the stomach (n=20, 10.6%) with ventilation difficulties when LTs without gastric drainage were used; malposition of the LT in the piriform sinus (n=1, 0.5%) and significant bleeding from soft tissue injuries (n=4, 2.1%).
  
  
  CONCLUSIONS
  The prehospital use of LTs may result in severe and even life-threatening complications. Likely, such complications could have been prevented by using gastric drainage and cuff pressure adjustment. Both, prehospital health care providers and emergency department staff should develop a greater awareness of such complications to best avoid them in the future.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Schalk
authors.affiliation: Department of Cardiology, Internal Medicine III, Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Florian H
authors.initials: FH
authors.lastname: Seeger
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Haitham
authors.initials: H
authors.lastname: Mutlak
authors.affiliation: Department of Orthopaedics and Trauma Surgery, BG Unfallklinik, Frankfurt, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schweigkofler
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Norman
authors.initials: N
authors.lastname: Peter
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany; Medical Campus University of Oldenburg, European Medical School, Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus, Oldenburg, Germany. Electronic address: christian.byhahn@uni-oldenburg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
mesh_terms: D000328:Adult; D058109:Airway Management / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004487:Edema / Q000209:etiology / Q000517:prevention & control; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D013271:Gastric Dilatation / Q000209:etiology / Q000517:prevention & control; D005858:Germany; D006801:Humans; D007440:Intubation / Q000009:adverse effects* / Q000379:methods; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D007830:Larynx / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016011:Normal Distribution; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014059:Tongue; D014132:Trachea / Q000293:injuries*
keywords: Airway management; Complications; Emergency medicine