Background In more than one-in-five cases of out-of-hospital cardiac arrest, the patient’s airway is soiled by vomit and blood. If a paramedic cannot clear the airway, the patient will die. A new method of clearing the airway called suction assisted laryngoscopy and airway decontamination (SALAD) has been developed, but it’s not known whether the method can assist paramedics to intubate. This study aims to determine whether paramedics can intubate a simulated soiled airway more often on their first attempt, using SALAD.

Methods A modified airway manikin, with the oesophagus connected to a reservoir of ‘vomit’ that was propelled up the oesophagus by a pump, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.

Results 164 paramedics took part in the study. First-pass intubation success with and without SALAD was 90.2% and 53.7% respectively, a significant difference of 36.6% (95%CI 24–49.1%, p<0.001). The mean successful intubation time for each attempt and patient group (AAB and ABB) was as follows: 61.8 (95%CI 55.8–67.8) and 59.4 (95%CI 53.6–65.1) seconds on the first attempt, 50.8 (95%CI 45.7–55.9) and 51.5 (95%CI 48.6–54.4) seconds on the second attempt and 53.5 (95%CI 50.4–56.6) and 46.6 (95%CI 44.0–49.1) seconds on the third attempt. There was no significant difference in success rates on the third attempt between AAB and ABB 89% vs 86.6% respectively, a difference of 2.4% (95%CI 7.6–12.4%, p=0.63).

Conclusions In this study, paramedics were able to intubate a simulated soiled airway on their first attempt, significantly more often when using the SALAD technique.