The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) - a prospective randomised manikin study

Thomas Ott, Matthias Fischer, Tobias Limbach, Irene Schmidtmann, Tim Piepho, Ruediger R Noppens, Thomas Ott, Matthias Fischer, Tobias Limbach, Irene Schmidtmann, Tim Piepho, Ruediger R Noppens

Abstract

Background: Supraglottic devices are helpful for inexperienced providers who perform ventilation in emergency situations. Most supraglottic devices do not allow secondary tracheal intubation through the device. The novel intubating laryngeal tube (iLTS-D) and the intubating laryngeal mask (Fastrach) are devices that offer supraglottic ventilation and secondary tracheal intubation.

Methods: We evaluated the novel iLTS-D and compared it to the established Fastrach using a manikin-based study. Participants used both devices in a randomised order. The participants conducted four consecutive trials on a manikin. One trial was composed of the following procedures. First, participants ventilated the manikin using either iLTS-D or Fastrach. 'Time to ventilation', success rates and number of attempts were recorded for the supraglottic device. Second, participants intubated the manikin through the previously inserted supraglottic device. 'Time to tracheal ventilation', success rate and tube localisation were recorded. The primary endpoint was the results of the final fourth trial, which mirrored the standardised training of trials 1, 2 and 3.

Results: A total of 64 participants were enrolled. All of the participants successfully inserted both devices on their first attempt in trial 4. Fastrach was applied 1 s faster in trial 4 than the iLTS-D (median 'time to ventilation' Fastrach: 13.5 s., iLTS-D: 14.5 s., p = 0.04). All participants successfully intubated through both devices in trial 4. There was no difference in 'time to tracheal ventilation' by tracheal intubation between either device (median 'time to tracheal ventilation': Fastrach: 14.0 s., iLTS-D: 14.0 s., p = 0.16).

Conclusion: The iLTS-D performed similarly to the ILMA in insertion and intubation times in a manikin setting.

Figures

Fig. 1
Fig. 1
The intubating laryngeal tube suction “iLTS-D”
Fig. 2
Fig. 2
“Time to ventilation” in seconds using the Fastrach (FT) and iLTS-D

References

    1. Bernhard M, Mohr S, Weigand MA, Martin E, Walther A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand. 2012;56(2):164–71. doi: 10.1111/j.1399-6576.2011.02547.x.
    1. American Society of Anesthesiologists Task Force on Management of the Difficult A Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98((5):1269–77.
    1. Henderson JJ, Popat MT, Latto IP, Pearce AC, Difficult Airway S. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004;59(7):675–94. doi: 10.1111/j.1365-2044.2004.03831.x.
    1. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010;81(10):1305–52. doi: 10.1016/j.resuscitation.2010.08.017.
    1. Henlin T, Michalek P, Tyll T, Hinds JD, Dobias M. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review. Biomed Res Int. 2014;2014:376871. doi: 10.1155/2014/376871.
    1. Schalte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N: Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin. Scand J Trauma Resus 2011, 19.
    1. Timmermann A, Russo SG, Rosenblatt WH, Eich C, Barwing J, Roessler M, et al. Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation. Br J Anaesth. 2007;99(2):286–91. doi: 10.1093/bja/aem136.
    1. Tritsch L, Boet S, Pottecher J, Joshi GP, Diemunsch P. Intubating laryngeal mask airway placement by non-physician healthcare providers in management out-of-hospital cardiac arrests: A case series. Resuscitation. 2013;85(3):320–5. doi: 10.1016/j.resuscitation.2013.11.006.
    1. Timmermann A, Russo SG, Crozier TA, Eich C, Mundt B, Albrecht B, et al. Novices ventilate and intubate quicker and safer via intubating laryngeal mask than by conventional bag-mask ventilation and laryngoscopy. Anesthesiology. 2007;107(4):570–6. doi: 10.1097/01.anes.0000281940.92807.23.
    1. Mihai R, Knottenbelt G, Cook TM. Evaluation of the revised laryngeal tube suction: the laryngeal tube suction II in 100 patients. Br J Anaesth. 2007;99(5):734–9. doi: 10.1093/bja/aem260.
    1. Balki M, Cooke ME, Dunington S, Salman A, Goldszmidt E. Unanticipated difficult airway in obstetric patients: development of a new algorithm for formative assessment in high-fidelity simulation. Anesthesiology. 2012;117(4):883–97. doi: 10.1097/ALN.0b013e31826903bd.
    1. Russo SG, Bollinger M, Strack M, Crozier TA, Bauer M, Heuer JF. Transfer of airway skills from manikin training to patient: success of ventilation with facemask or LMA-Supreme (TM) by medical students. Anaesthesia. 2013;68(11):1124–31. doi: 10.1111/anae.12367.
    1. Fischer H, Hochbrugger E, Fast A, Hager H, Steinlechner B, Koinig H, et al. Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation. 2011;82(3):326–31. doi: 10.1016/j.resuscitation.2010.11.014.
    1. Jordan GM, Silsby J, Bayley G, Cook TM, Difficult Airway S. Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills. Anaesthesia. 2007;62(7):708–12. doi: 10.1111/j.1365-2044.2007.05069.x.
    1. Timmermann A, Russo SG, Crozier TA, Nickel EA, Kazmaier S, Eich C, et al. Laryngoscopic versus intubating LMA guided tracheae intubation by novice users - A manikin study. Resuscitation. 2007;73(3):412–6. doi: 10.1016/j.resuscitation.2006.10.019.
    1. Nakstad AR, Sandberg M. Airway management in simulated restricted access to a patient - can manikin-based studies provide relevant data? Scand J Trauma Resus. 2011;19.
    1. Sunde GA, Brattebo G, Odegarden T, Kjernlie DF, Rodne E, Heltne JK. Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway. Scand J Trauma Resus. 2012;20.
    1. Wenk M, Waurick R, Schotes D, Wenk M, Gerdes C, Van Aken HK, et al. Simulation-based medical education is no better than problem-based discussions and induces misjudgment in self-assessment. Advances in health sciences education : theory and practice. 2009;14(2):159–71. doi: 10.1007/s10459-008-9098-2.
    1. Owen H, Plummer JL. Improving learning of a clinical skill: the first year's experience of teaching endotracheal intubation in a clinical simulation facility. Med Educ. 2002;36(7):635–42. doi: 10.1046/j.1365-2923.2002.01260.x.
    1. Russi CS, Wilcox CL, House HR. The laryngeal tube device: a simple and timely adjunct to airway management. Am J Emerg Med. 2007;25(3):263–7. doi: 10.1016/j.ajem.2006.03.018.
    1. Bernhard M, Beres W, Timmermann A, Stepan R, Greim CA, Kaisers UX, et al. Prehospital airway management using the laryngeal tube. An emergency department point of view Anaesthesist. 2014;63(7):589–96.
    1. Cinar O, Cevik E, Yildirim AO, Yasar M, Kilic E, Comert B. Comparison of GlideScope video laryngoscope and intubating laryngeal mask airway with direct laryngoscopy for endotracheal intubation. Eur J Emerg Med. 2011;18(2):117–20. doi: 10.1097/MEJ.0b013e32833e79e6.
    1. Castle N, Pillay Y, Spencer N. Comparison of six different intubation aids for use while wearing CBRN-PPE: A manikin study. Resuscitation. 2011;82(12):1548–52. doi: 10.1016/j.resuscitation.2011.06.020.
    1. Sherren PB, Kong ML, Chang S. Comparison of the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway in a difficult airway with manual in-line stabilisation A cross-over simulation-based study. Eur J Anaesth. 2013;30(9):544–9. doi: 10.1097/EJA.0b013e3283615b80.
    1. Wahlen BM, Roewer N, Lange M, Kranke P. Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study. Anaesthesia. 2009;64(5):549–54. doi: 10.1111/j.1365-2044.2008.05812.x.
    1. Theiler L, Kleine-Brueggeney M, Urwyler N, Graf T, Luyet C, Greif R. Randomized clinical trial of the i-gel (TM) and Magill tracheal tube or single-use ILMA (TM) and ILMA (TM) tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway. Brit J Anaesth. 2011;107(2):243–50. doi: 10.1093/bja/aer102.
    1. Karim YM, Swanson DE. Comparison of blind tracheal intubation through the intubating laryngeal mask airway (LMA Fastrach (TM)) and the Air-Q (TM) Anaesthesia. 2011;66(3):185–90. doi: 10.1111/j.1365-2044.2011.06625.x.
    1. Mann V, Mann ST, Alejandre-Lafont E, Rohrig R, Weigand MA, Muller M: Supraglottic airway devices in emergency medicine. Impact of gastric drainage. Anaesthesist 2013, 62(4):285 − +.
    1. Dengler V, Wilde P, Byhahn C, Mack MG, Schalk R. Prehospital airway management of laryngeal tubes. Should the laryngeal tube S with gastric drain tube be preferred in emergency medicine? Anaesthesist. 2011;60(2):135–8. doi: 10.1007/s00101-010-1774-y.
    1. Gaitini LA, Vaida SJ, Somri M, Yanovski B, Ben-David B, Hagberg CA. A randomized controlled trial comparing the ProSeal (TM) laryngeal mask airway with the laryngeal tube suction in mechanically ventilated patients. Anesthesiology. 2004;101(2):316–20. doi: 10.1097/00000542-200408000-00011.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere