Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation.

BACKGROUND Out-of-hospital airway management is a critical skill, demanding expert knowledge and experience. The intubating laryngeal mask airway (ILMA) is a ventilatory and intubating device which may be of value in this arena. We evaluated the ILMA for out-of-hospital management of the difficult airway. METHODS Twenty-one anaesthesia-trained emergency physicians (EPs) completed a training programme and used the ILMA in patients with difficult-to-manage airways. Indications for use of the ILMA included patients with difficult laryngoscopy, multiple intubation attempts, limited access to the patient's head, presence of pharyngo-laryngeal trauma, and gastric fluids or bleeding obscuring the view of the vocal cords. RESULTS During the study period, 146 of 2513 patients underwent tracheal intubation or alternate rescue airway insertion. In 135 patients, laryngoscopy was performed and Cormack-Lehane view was recorded as grade I in 72 (53.3%), II in 45 (33.3%), III in 10 (7.4%), and IV in 8 (5.9%). EPs encountered 11 patients (7.5%) with difficult-to-manage airways. ILMA insertion and ventilation was possible in 10 patients in the first and one patient in the second attempt. ILMA-guided tracheal intubation was successful in all patients, in 10 after the first and in 1 after two attempts. CONCLUSIONS In this study, ventilation and intubation with ILMA was successful in all patients with difficult-to-manage airways. Our data support the use of the ILMA as rescue device for out-of-hospital airway management by staff who have appropriate airway skills and have received appropriate training.