Supraglottic airway device use as a primary airway during RSI

Supraglottic Airway Device Use as a Primary Airway During Rapid Sequence Intubation

Air Medical Journal: Volume 32, Issue 2 , Pages 93-97, March 2013

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum


This study compared first-attempt placement success rates of the King LTS-D as a primary airway for patients requiring medication-assisted airway management (MAAM) against historical controls.

Method: 53 providers (RNs/EMT-P) consented to participation and were trained in the use of the King LTS-D. All patients in need of MAAM per agency treatment guidelines were screened for inclusion and exclusion criteria. After each placement attempt, providers completed data collection via telephone. The primary endpoint was comparison of first-attempt placement success rate between the King LTS-D and historical control endotracheal intubation (ETI) MAAM patients. Overall placement success, time to placement, pre- and post-placement SaO2, ETCO2 at 2 minutes after placement, and complications were also analysed.

Results: 38 patients received rapid sequence intubation with the King LTS-D by 23 of 58 consented providers. First-attempt success rate was 76% (29/38), with an overall success rate of 84% (32/38). The primary endpoint analysis showed no difference in first-attempt success rate between historical control ETI MAAM data and King LTS-D (71% vs 76%; OR = 0.1.34 [95% CI Intubation time to insertion was 26 seconds (IQR = 12–46). Pre- and post-insertion SaO12 values were 88.9 ± 12.6% and 92.1 ± 12.7%, respectively. Mean ETCO2 at 2 minutes after placement was 34.8 ± 4.0. Vomit in the patient’s airway was the most frequently reported complication (46%).

The authors found that the success rates with the King LTS-D were not significantly different from historical control ETI data with no major difference in the time to placement when compared with previous reports. On a personal opinion, if using a supraglottic airway device takes the same time to insert and has similar success rates as endotracheal intubation, surely endotracheal intubation should be the first choice option (especially with nearly 50% of patients having vomit in the airway), keeping supraglottic devices  as part of a failed intubation procedure?

http://www.airmedicaljournal.com/article/S1067-991X(12)00175-7/abstract?elsca1=etoc&elsca2=email&elsca3=1067-991X_201303_32_2&elsca4=emergency_medicine

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