Restricted Access to Patent Airway - @

Restricted Access to Patent Airway

Street Science



Keith Wesley, MD, FACEP | | Monday, August 20, 2007

Review of: Hoyle JD, Jones JS, Deibel M, et al: Comparative study of airway management techniques with restricted access to patient airway. Prehospital Emergency Care. 11(3):330-336, 2007.

The Science

This study conducted by the Grand Rapids Medical Education and Research Center examines the number of attempts required and the time to successfully ventilate a mannequin placed in non-traditional scenarios. They compared the endotracheal tube (ET), Combitube (CT) and the Laryngeal Mask Airway (LMA). They also compared the times and success rates of 25 emergency medicine residents, nine emergency medicine faculty and 22 paramedics.

The mannequins were placed in one of three positions: 1) supine under a table with the head abutting a table and a table overlying them, 2) sitting upright with access only from behind, and 3) lying on its side with access only by lying on the floor facing it. The supine and side scenarios simulated a confined-space rescue, and the access from behind simulated a trapped-vehicle patient.

They found no significant difference between residents, faculty and paramedics in the number of attempts needed to successfully ventilate the mannequin. EMT-Ps demonstrated significantly faster times to successful ventilation for all scenarios versus physicians except for the mannequin lying on its side, for which no significant difference was noted. Specifically, in the supine scenario with ET, the EMT-P median time was 57 seconds, whereas the physician median time was 96 seconds. The time to ventilation for all scenarios was less with the LMA versus ET, or CT versus ET, except in the sitting scenario where ET and CT were comparable

They concluded, In this mannequin model of restricted airway access, LMA resulted in significantly faster times to ventilation versus ET and CT in all but one scenario.

The Street

Finally! We re starting to realize that intubation in the prehospital setting requires a unique knowledge and skill set. Despite having less experience with both ET and LMA, the paramedics were able to ventilate the patient in less time than the doctors. Perhaps this is, as the authors noted, a reflection of the fact that paramedics often have little help in the field and must be confident in dealing with such life-threatening scenarios on their own.

This further reinforces my belief that, just like the military, train like you fight and you will fight like you train. Prehospital intubation is never like the sterile environment of the OR, and we should support training and educating our providers to deal with real life scenarios.

Clearly, the role of non-visualized airways is highlighted by this study. Although debate continues over which is the most appropriate device, this study shows that the LMA is more efficient. It will be interesting to see similar studies comparing these devices with the King LT and Cobra.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Airway and Respiratory, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Innovation & Advancement

This is the seventh year of the EMS 10 Innovators in EMS program, jointly sponsored by Physio-Control and JEMS.
More >

Multimedia Thumb

Press Conference, East Village Explosion and Collapse

Fire is contained to four buildings; 12 people have been injured.
Watch It >

Multimedia Thumb

D.C. Mayor Adds Ambulances to Peak Demand Period

10 additional ambulances will be on the streets from 11 a.m. to 11 p.m.
Watch It >

Multimedia Thumb

Utah Commission Privatizes Ambulance Service

Mayors in Iron County loose management fight.
Watch It >

Multimedia Thumb

Ambulance Delay Raises Concerns over Response Times

Officers give up after waiting 20 minutes for an ambulance.
Watch It >

Multimedia Thumb

Patient Carry during Snowstorm

Firefighters, medics and officers lend a hand in Halifax.
More >

Multimedia Thumb

Terror Attack in Tunisia

19 people killed outside of a museum.
More >