Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes☆☆☆
Received 10 August 2009; received in revised form 8 November 2009; accepted 12 November 2009. published online 14 December 2009.
Abstract
Concept
Endotracheal intubation (ETI) is considered to be the gold standard of prehospital airway management. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers less experienced in ETI. We prospectively evaluated the feasibility of laryngeal tubes used by paramedics and emergency physicians for out-of-hospital airway management.
Material and methods
During a 24-month period, all cases of prehospital use of the laryngeal tube disposable (LT-D) and laryngeal tube suction disposable (LTS-D) within five operational areas of emergency medical services were recorded by a standardised questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time and personal level of experience.
Results
Of 157 prehospital intubation attempts with the LT-D/LTS-D, 152 (96.8%) were successfully performed by paramedics (n=70) or emergency physicians (n=87). The device was used as initial airway (n=87) or rescue device after failed ETI (n=70). The placement time was ≤45s (n=120), 46–90s (n=20) and >90s (n=7). In five cases the time needed was not specified. The number of placement attempts was one (n=123), two (n=25), three (n=2) and more than three (n=2). The majority of users (61.1%) were relative novices with no more than five previous laryngeal tube placements.
Conclusion
The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed.
aClinic of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, J.W. Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany
bDistrict of Hochtaunuskreis, D-61250 Usingen, Germany
cMunicipality of Frankfurt, Fire Department, Paramedic School, D-60435 Frankfurt, Germany
dDepartment of Trauma Surgery, J.W. Goethe University Hospital Frankfurt, D-60590 Frankfurt, Germany
eMunicipality of Frankfurt, Public Health Department, D-60313 Frankfurt, Germany
ABSTRACT