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Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics

¹ Hampshire Ambulance Service NHS Trust, Winchester, UK
² Medical School, Southampton University Hospital Trust, Southampton, UK

Correspondence to:
Correspondence to:
Dr C D Deakin
Hampshire Ambulance Service NHS Trust, Highcroft, Romsey Road, Winchester SO22 5DH, UK; charlesdeakin{at}doctors.org.uk

ABSTRACT
Objectives: The recent introduction of a disposable laryngeal mask airway has provided paramedics with an alternative to endotracheal intubation. Time taken to secure the airway with each device was compared in patients undergoing elective surgery.

Methods: Patients undergoing general anaesthesia were studied. Paramedics trained in laryngeal mask use and endotracheal intubation participated in the study. A Portex disposable laryngeal mask was inserted and removed, followed by a Portex endotracheal tube. Time taken from beginning of the procedure to ventilation of the patient was recorded.

Results: Laryngeal mask insertion and endotracheal intubation was attempted on 52 patients. Median age was 63.5 years (range 39–83). Laryngeal mask insertion was successful in 88.5% (46 of 52) patients; endotracheal intubation was successful in 71.2% (37 of 52) patients (after no more than two attempts), p = 0.049. Intubation success was related to laryngoscopic view (87.5% grade 1, 56.3% grade 2, 0.0% grade 3. p<0.0001). When laryngeal mask/endotracheal tube insertion were both successful (n = 35 of 52), there was no significant difference in median time to secure the airway (laryngeal mask 47.0 seconds (range 24–126) compared with endotracheal tube 52.0 seconds (range 27–148) p = 0.22). Laryngeal mask insertion was successful in 80.0% (12 of 15) patients in whom endotracheal intubation had failed.

Conclusions: Even under optimal conditions, 30% of attempts at intubation by paramedics were unsuccessful. A disposable laryngeal mask has a higher success rate in securing the airway and overall, secures the airway more reliably than endotracheal intubation.

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