Paramedic Endotracheal Intubation using the Intubating Laryngeal Mask Airway

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Mike McCall¹ Mark Reeves² Marcus Skinner² Corinne Ginifer² Paul Myles³ Noel Dalwood¹

1 Tasmanian Ambulance Service, Tasmania
2 North West Regional Hospital, Burnie, Tasmania
3 Monash University, Victoria

Purpose of Study

Tracheal intubation through the intubating laryngeal mask airway (ILMA) has been evaluated, in controlled settings, as an acceptable alternative to laryngoscopic intubation. Our observational study was designed to examine the success rate of tracheal intubation using the intubating laryngeal mask airway in the prehospital setting after mannequin-based training.

Method

After obtaining institutional ethics approval we examined all oral tracheal intubations performed by the Tasmanian Ambulance Service (TAS) from April 2005 to April 2006. TAS Paramedics are occasional intubators, on average performing four intubations per paramedic per year. Fifty eight paramedics received training in tracheal intubation through the ILMA, 13 (22%) were not advanced airway management trained. The primary outcome measure was the success or failure of ILMA insertion with subsequent blind tracheal intubation. Our hypothesis was that paramedics would be able to successfully perform out-of-hospital tracheal intubation using the ILMA with minimal training.

Result

During the study period, 106 patients had out-of-hospital tracheal intubation performed by ambulance paramedics. Comparisons were made between the intubations with the ILMA and by laryngoscopy. The overall intubation success rate was 91% using the laryngoscope and 92% when using the ILMA. The success rate for the first attempt at intubation was higher with ILMA (81%) than with direct laryngoscopy (57%) (RR 1.43: 95%CI 1.07 – 1.90), regardless of ultimate success. The success rate when intubating unconscious patients using the ILMA was significantly higher (88%) than intubation using the laryngoscope (63%). These intubations were achieved without the administration of any sedation or paralytic medication.

Conclusion

Intubation using the ILMA was as successful as conventional laryngoscopy and required less formal training.

Time of Presentation: 1530