title: In a difficult access scenario, supraglottic airway devices improve success and time to ventilation.
abstract: The success of tracheal intubation (TI) is unacceptably low in unconventional positions. Supraglottic airway devices (SAD) have become an important alternative. An airway manikin was placed in a car, simulating an entrapped motor vehicle accident victim. The rescuer only had access through the driver's door. Participants were (n = 25) anaesthesiologists with experience in prehospital emergency medicine. They attempted to secure the airway by TI or an SAD (Ambu AuraOnce, iGel, laryngeal tube) in a random sequence. Performance was compared using the Wilcoxon signed-rank test. P values less than 0.05 were considered statistically significant. Fastest effective ventilation was achieved with iGel (11.5 ± 6.9 s, P < 0.001), followed by a laryngeal mask (15.1 ± 5.6 s, P < 0.001) and a laryngeal tube (17.6 ± 5.3 s, P < 0.001); TI was the slowest (42.8 ± 23.9 s, comparator). iGel (P < 0.001) and laryngeal mask (P = 0.01) also significantly outperformed the laryngeal tube. First ventilation was achieved significantly faster with SADs compared with TI. Success rates were also higher when using SADs.
authors.affiliation: aDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne bInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wetsch
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneider
authors.forename: Robert
authors.initials: R
authors.lastname: Schier
authors.forename: Oliver
authors.initials: O
authors.lastname: Spelten
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Jochen
authors.initials: J
authors.lastname: Hinkelbein
mesh_terms: D000063:Accidents, Traffic; D058109:Airway Management / Q000295:instrumentation* / Q000379:methods; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D005931:Glottis; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods; D017214:Laryngeal Masks; D008348:Manikins; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods