BJA Advance Access originally published online on June 21, 2007
British Journal of Anaesthesia 2007 99(2):286-291; doi:10.1093/bja/aem136
Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation
1 Department of Anaesthesiology, Emergency, and Intensive Care Medicine, Georg-August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
2 Department of Anaesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT 06520-8051, USA
* Corresponding author. E-mail: atimmer{at}zari.de
Background: Out-of-hospital airway management is a critical skill, demanding expert knowledge and experience. The intubating laryngeal mask airway (ILMA) is a ventilatory and intubating device which may be of value in this arena. We evaluated the ILMA for out-of-hospital management of the difficult airway.
Methods: Twenty-one anaesthesia-trained emergency physicians (EPs) completed a training programme and used the ILMA in patients with difficult-to-manage airways. Indications for use of the ILMA included patients with difficult laryngoscopy, multiple intubation attempts, limited access to the patient’s head, presence of pharyngo-laryngeal trauma, and gastric fluids or bleeding obscuring the view of the vocal cords.
Results: During the study period, 146 of 2513 patients underwent tracheal intubation or alternate rescue airway insertion. In 135 patients, laryngoscopy was performed and Cormack–Lehane view was recorded as grade I in 72 (53.3%), II in 45 (33.3%), III in 10 (7.4%), and IV in 8 (5.9%). EPs encountered 11 patients (7.5%) with difficult-to-manage airways. ILMA insertion and ventilation was possible in 10 patients in the first and one patient in the second attempt. ILMA-guided tracheal intubation was successful in all patients, in 10 after the first and in 1 after two attempts.
Conclusions: In this study, ventilation and intubation with ILMA was successful in all patients with difficult-to-manage airways. Our data support the use of the ILMA as rescue device for out-of-hospital airway management by staff who have appropriate airway skills and have received appropriate training.
Keywords: airway, complications; airway, patency; complications, intubation tracheal; equipment, airway