Laryngeal Tube Suction-D, Combitube, and Proseal Laryngeal Mask Airway: Randomized Clinical Trial

Background: The Esophageal Tracheal CombitubeTM (ETC), Disposable Laryngeal Tube SuctionTM (LTS-D), and ProSeal Laryngeal Mask AirwayTM (PLMA) are devices that can secure the airway and maintain access to the stomach in at-risk patients, such as trauma or non fastened patients, when endotracheal intubation is difficult or impossible. Methods: We conducted a randomized controlled trial with the following primary endpoints: duration of intubation, successful placement on first attempt, leak pressures, and post-operative morbidity (dysphagia, sore throat). Results: The ETC (n=71), LTS-D (n=73), and PLMA (n=72) groups showed significant differences in the likelihood of successful insertion on first attempt (70.0%, 89.0%, and 72.2%, respectively), p=0.012. There was no significant difference in successful insertion rate among the ETC (90.1%), LTS-D (94.5%), and PLMA (93.1%) groups, p=0.6. Cuff pressure was significantly greater in the ETC group (284.2±63.0 cm H2O) compared to each of the LTS-D (72.0±15.7 cm H2O), and PLMA (72.3±21.7 cm H2O) groups, p<0.00001. Cuff volume was significantly greater in the ETC group (84.0±9.1 cc) compared to each of the LTS-D (64.8±12.4 cc) and PLMA (31.3±17.9cc) groups, p<0.00001, and was significantly greater in the LTS-D group compared to the PLMA group, p<0.00001. Prevalence of severe sore throat and dysphagia was greater in the ETC group compared to the other groups, both at 2 hours (p<0.003) and 24 hours (p<0.0001) after securing the airway. Conclusion: The ETC is an airway device resulting in greater cuff volume and pressure compared to LTS-D and PLMA, decreased likelihood of successful insertion on first attempt compared to LTS-D, and greater prevalence of sore throat and dysphagia compared to LTS-D and PLMA, without any significant differences in insertion time.