Comparison of Airway Management Methods in Entrapped Patients: A Manikin Study

Abstract

Introduction: Endotracheal intubation remains one of the most challenging skills in prehospital care. There is a minimal amount of data on the optimal technique to use when managing the airway of an entrapped patient. We hypothesized that use of a blindly placed device would result in both the shortest time to airway management and highest success rate. Methods: A difficult airway manikin was placed in a cervical collar and secured upside down in an overturned vehicle. Experienced paramedics and prehospital registered nurses used four different methods to secure the airway: direct laryngoscopy, digital intubation, King LT-D, and CMAC video laryngoscopy. Each participant was given three opportunities to secure the airway using each technique in random order. A study investigator timed each attempt and confirmed successful placement, which was determined upon inflation of the manikin's lungs. Intubation success rates were analyzed using a general estimating equations model to account for repeated measures and a linear mixed effects model for average time. Results: Twenty-two prehospital providers participated in the study. The one-pass success rate for the King LT-D was significantly higher than direct laryngoscopy (OR 0.048, CI 0.006–0.351, p < 0.01) and digital intubation (OR 0.040, CI 0.005–0.297, p < 0.01). However, there was no statistical difference between the one-pass success rate of the King LT-D and CMAC video laryngoscopy (OR 0.302, 95% CI 0.026–3.44, p = 0.33). The one-pass median placement time of the King LT-D (22 seconds, IQR 17–26) was significantly lower (p < 0.001) than direct laryngoscopy (60 seconds, IQR 42–75), digital intubation (38 seconds, IQR 26–74), and the CMAC (51 seconds, IQR 43–76). Conclusions: In this study, while the King LT-D offered the quickest airway placement, success rates were not significantly greater than intubation using the CMAC video laryngoscope. Intubation using direct laryngoscopy and digital intubation were less successful and took more time. Use of a blindly placed device or a video laryngoscope may provide the best avenues for airway management of entrapped patients.

Key words::

• airway management
• confined spaces
• intubation
• intratracheal
• video laryngoscopy
• laryngeal masks