title: Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study.
abstract: BACKGROUND
  Emergency Medical Service (EMS) personnel manage the airway, but only a group of them are allowed to engage in Endotracheal Intubation (ETI). Our purpose was to evaluate if the use of laryngeal mask airway (LMA) or Combitube can be used by inexperienced care providers.
  
  
  METHODS
  A randomized, prospective manikin study was conducted. Fifty-nine participants were randomly assigned into two groups. Experienced group included 16 paramedics, eight anesthetic-technicians, and inexperienced group included 27 Emergency Medical Technician-Basic (EMT-B) and eight nurses. Our main outcomes were success rate and time to airway after only one attempt.
  
  
  RESULTS
  Airway success was 73% for ETI, 98.3% for LMA, and 100% for Combitube. LMA and Combitube were faster and had greater success than ETI (P = 0.0001). Inexperienced had no differences in time to securing LMA compared with experienced (6.05 vs. 5.4 seconds, respectively, P = 0.26). One failure in inexperienced, and no failure in experienced group occurred to secure the LMA (P = 0.59). The median time to Combitube placement in experienced and inexperienced was 5.05 vs. 5.00 seconds, P = 0.65, respectively. Inexperienced and experienced groups performed ETI in 19.15 and 17 seconds, respectively (P = 0.001). After the trial, 78% preferred Combitube, 15.3% LMA, and 6.8% ETI as the device of choice in prehospital setting.
  
  
  CONCLUSIONS
  Time to airway was decreased and success rate increased significantly with the use of LMA and combitube compared with ETI, regardless of the experience level. This study suggests that both Combitube and LMA may be acceptable choices for management of airway in the prehospital setting for experienced and especially inexperienced EMS personnel.
authors.affiliation: Department of Emergency, Tehran University of Medical Sciences, Tehran, Iran ; Department of Emergency Medicine, Pre-Hospital Emergency Research Center, Shariati Hospital, Tehran Univeristy of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Saeedi
authors.affiliation: Department of Emergency, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Houman
authors.initials: H
authors.lastname: Hajiseyedjavadi
authors.affiliation: Department of Emergency, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Seyedhosseini
authors.affiliation: Department of Emergency, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Eslami
authors.affiliation: Department of Emergency, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hojat
authors.initials: H
authors.lastname: Sheikhmotaharvahedi
keywords: Combitube; endotracheal tube; laryngeal mask airway; prehospital